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Surgical Neuromonitoring

  1. Question Surgical Neuromonitoring
    Medical Coding Books
    Equipment is personally owned by the Professional Neuromonitor used in the ER. She owns the equipment ( not the facility and facility is not billing for the use of the equipment) She conducts the testing during the surgery and also does the interpertation of the testing. I am having trouble getting this paid for both the Technical and Professional components.
    95920 2.75
    95861 3
    95925 1
    95926 1
    95929 1
    95928 4
    elec: 41 (A4557)

    I bill the appropriate modifiers ie: 26 TC with the codes and they are either denied for only the 26 being allowed per MCR.
    Any suggestions?????????

  2. #2
    Location
    Sioux Falls South Dakota
    Posts
    358
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    Quote Originally Posted by dbawagner View Post
    Equipment is personally owned by the Professional Neuromonitor used in the ER. She owns the equipment ( not the facility and facility is not billing for the use of the equipment) She conducts the testing during the surgery and also does the interpertation of the testing. I am having trouble getting this paid for both the Technical and Professional components.
    95920 2.75
    95861 3
    95925 1
    95926 1
    95929 1
    95928 4
    elec: 41 (A4557)

    I bill the appropriate modifiers ie: 26 TC with the codes and they are either denied for only the 26 being allowed per MCR.
    Any suggestions?????????
    We had a similar situation with our Internal Medicine clinic; they owned a piece of equipment that the hospital did not have; they would wheel it over to the hospital and use it, then attempt to bill global. Medicare and most other insurances would not allow that, because in most cases, equipment is owned by the hospital and physicians/NPPs should only bill the professional component. I spoke with both our Medicare and BCBS reps; they advised that they would never pay the global for this. I then spoke with the clinic manager and advised that she come to an agreement with the hospital that they would rent the equipment when it needed to be used, and they (hospital) would then bill the insurance for the technical component, while the office would only bill the interpretation. This has worked for us.

    I hope this helps,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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