Wiki Surgical Monitoring, Standby & Reporting question

[bonzaibex]

I'm very new to this category, and I need some experienced advice. I've got a physician coding a 95920-26, 95925-26, 95926-26, 95861-26, & 95957-26. He is NOT in attendance during the surgery. He is available if needed for phone consult during surgery; otherwise he is reviewing all data afterward & providing a report. Questions:

95920 - he's not actually in the OR at any time. There's a tech doing the monitoring. My physician is just reviewing the data afterward. Unless I'm reading the CPT guideline wrong, he should not be coding this one, correct? He does have a paragraph in his report under the heading "Intra-Operative Responses."

95925 vs 95926 - why does CPT state "do not report" these 2 together? One is for upper limbs & one is for lower limbs. Usually I can easily understand the "don't bill in conjunction with" notations, but this one has me stumped.

If the 95920 is incorrect for his situation, is there a stand-by code he can bill?

Anything else I need to know about this service/category? Anyone have any educational links they care to share? Constructive advice is greatly appreciated.

Becky, CPC
Denver CO

 

[aaron.lucas]

95925 and 95926 cant be billed together for 2012 because there's a new combo code, 95938 that says upper and lower. as for 95920, you're correct, the doctor has to be there in order to monitor the patient, so he cant bill that, and there is no stand-by code. also as far as I know, the EMG should only be billed if the provider is there doing real-time interpretation for that as well. the other ones I'm not sure about, but I would think he should be there to monitor those as well, because it doesnt do the patient any good if the doctor isnt there to advise the surgeon. in the time it would take to call him, if something did go wrong there could be a lot of damage done. anybody else have thoughts on this?

 

[bonzaibex]

Thank you very much, Aaron. I can't believe I missed that combo code!! (Note to self - don't rely on a CPT page copy provided by someone else without verifying the year of said book...duh).

I did find another interesting piece of research that I thought I'd share... The neuro CAN be offsite for the 95920 code, according to Medicare guidelines. Medicare states a certified technician must be in the OR, and the neurologist must have an online-real time connection with that tech plus immediate access to the surgeon. As long as the neurologist is paying one-on-one attention to the case being monitored, s/he can do so remotely.

 

[aaron.lucas]

LOL, you're welcome. Yeah, it can be tricky sometimes when you're dealing with recent CPT changes. I train coders for the company I work for, and whenever we have a situation with old code/new code, I always remind them to use the book that goes with the year the service was performed, because the code could be different, deleted, or there could be new parenthetical notes that affect how the code is used. That is interesting though, that they can be off-site, I would think the time it takes to make a phone call could be the difference between life and death, I dont know... Now if that's Medicare, I wonder what AMA says, if anything? And will everyone pay for it if the doctor is not there? I know most follow CMS's lead, but you never know. Thanks for the additional info though!

 

[bonzaibex]

I ended up doing a lot of research on this after I posted the original query here. The Medicare guidelines have been in place at least since 2006, at least that's the date of the Neurology Coding Alert article I found. The article ("Is Coding for IOM Testing Your Patience? Help Is Here" published 2006-01-01) does emphasize checking individual carriers for their own guidelines &/or LCDs, and specifically states to ask the insurer how to record the POS when monitoring remotely. But I didn't rely solely on info from 2006 about Medicare - I verified it with our MAC's current guidelines, and the LCD hasn't changed. Evidently there are a few neurologists who do this kind of remote monitoring - they have several computers, each dedicated to an individual case, and as long as the neuro is "solely dedicated to performing this service," s/he may monitor several patients at once.

Like you said, additional info for thought. I teach coding also, and I am continually humbled by how much I don't know. But every time I learn something new, my cerebral lighbulb burns a little brighter. ;-)