Basics of Billing & Coding Intraoperative NeuroMonitoring

1 Sarah J Raddatz, BS CPC Director Basics of Billing & Coding Intraoperative NeuroMonitoring Disclaimer The following presentations are not to be considered a replacement for the Current Procedural Terminology (CPT) book or the International Classification of Diseases 9th Revision-Clinical Modification (ICD-9-CM) book. It is designed simply as a resource to help you obtain a better understanding of IONM Coding . Always refer back to the full Current Procedural Terminology (CPT) book when Coding . Current Procedural Terminology (CPT) is copyright 2012 American Medical Association.

2 All Rights Reserved. No fee schedules, basic units, relative values, or related listing are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a trademark of the American Medical Association. International Classification of Diseases 9th Revision-Clinical Modification (ICD-9-CM) is copyright 2012 Ingenix. All Rights Reserved. Education Disclaimer: The information provided is general Coding / Billing information only it is not legal advice; nor is it advice about how to code, complete or submit any particular claim for payment.

3 It is always the provider s responsibility to determine and submit appropriate codes, charges, modifiers and bills for services rendered. This Coding and reimbursement information is subject to change without notice. Before filing any claims, providers should verify current requirements and policies with the payer. PROCEDURES/ MODALITIES CARRIER POLICIES CPT / ICD-9 CODES MAXIMUM REIMBURSEMENT PROCEDURES/ MODALITIES SURGICAL PROCEDURE MODALITIES CPT Coding Surgical Procedures Modalities Cervical Spine Lumbar Spine Thoracic Spine Craniotomy Parotidectomy Thyroidectomy Carotid Endarterectomy Aneurysm Clipping SSEP sEMG tEMG TOF TcEMEP SNAP Vocal Cord EMG Cranial Nerve EMG ABR EEG CARRIER POLICIES National Coverage Determination The Centers for Medicare and Medicaid Services (CMS) publishes National Coverage Determination (NCD)

4 Manuals. In the case of Intraoperative neurophysiological testing, no national coverage determination exists in the current manuals published by CMS. Local Coverage Determination Medicare carriers vary from state to state although some are common across states Each intermediary contracts to the Centers for Medicare and Medicaid Services Each individual carrier publishes policies which outline the rules and regulations regarding the use of a particular CPT code, indications and limitations of coverage and/or medical necessity and physician supervision.

5 Centers for Medicare and Medicaid Services Wisconsin Physician Service Health Insurance Part A Provider Iowa, Kansas, Missouri, Nebraska, Indiana, Michigan Part B Provider Iowa, Kansas, Missouri, Nebraska, Indiana, Michigan, Illinois, Minnesota, Wisconsin. Local Coverage Determination L30721 Intraoperative Neurophysiological Testing Revision effective date 10/22/2012 Limitations For reimbursement this test must be requested by the operating surgeon and the monitoring must be performed by a physician, other than: The operating surgeon; The technical/surgical assistant; or The anesthesiologist rendering the anesthesia.

6 It is also expected that a specifically trained technician, preferably registered with one of the credentialing organizations will be in continuous attendance in the operating room, recording and monitoring a single surgical case, with either the physical or electronic capacity for real-time communication with the supervising neurologist or other physician trained in neurophysiology. Wisconsin Physician Service Health Insurance Local Coverage Determination Intraoperative Neurophysiological Testing Limitations (Continued) Undivided attention to a unique patient may be required during some surgeries, such as during response to acute events or identification of the cerebral cortex to be resected or spared from resection.

7 The monitoring physician must have a plan in place to transfer care to another physician of any other case during those times. When paying undivided attention to a unique patient, the physician must code and bill only for that one case during those times. For other medically necessary Intraoperative neurophysiologic monitoring, a physician may code and bill for up to three cases simultaneously. ICD-9 Codes that Support Medical Necessity Local Coverage Determination L31346 Nerve conduction studies and Electromyography Revision effective date 10/22/2012 Limitations Nerve conduction studies Each descriptor (code) from codes 95900, 95903, 95904, 95933, 95934, 95936, can be reimbursed only once per nerve, or named branch of a nerve, regardless of the number of sites tested or the number of methods used on that nerve.

8 ICD-9 Codes that Support Medical Necessity Wisconsin Physician Service Health Insurance CMS Local Coverage Determination Local Coverage Determination Intraoperative Neurophysiological Testing L32491 First Coast Service Options Puerto Rico Florida Virgin Islands L32605 Novitas Solutions Inc Arkansas Louisiana Mississippi Colorado New Mexico Oklahoma Texas L31748 Trailblazer Health Enterprises LLC Colorado New Mexico Oklahoma Texas L31748 Palmetto GBA South Carolina West Virginia North Carolina Virginia CMS Local Coverage Determination Local Coverage Determination Intraoperative Neurophysiological Testing Commercial Carrier Policies BLUE CROSS BLUE SHIELD - IL ANTHEM BLUE CROSS BLUE SHIELD (MISSOURI) No IONM Coverage Policy Commercial Carrier Policies BLUE CROSS BLUE SHIELD ALABAMA Effective for dates of services on or after November 1, 2012.

9 Intraoperative monitoring, which includes somatosensory-evoked potentials, motor-evoked potentials using transcranial electrical stimulation, brainstem auditory-evoked potentials, EMG of cranial nerves, EEG, and electrocorticography (ECoG), meets Blue Cross and Blue Shield of Alabama s medical criteria for coverage during spinal, intracranial, or vascular procedures when all the following criteria are met: 1. There is clinical data in the medical record to support the medical necessity of ordering the test. The data could include radiological, neurological, consultative notes, or physical exam documentation; and 2.

10 A licensed physician other than the operating surgeon or performing anesthesiologist must monitor the procedure and the monitoring physician must be available to be in the operating room; and 3. The monitoring physician interprets no more than three cases concurrently. Intraoperative monitoring of visual-evoked potentials does not meet Blue Cross and Blue Shield of Alabama s medical criteria for coverage and is considered investigational. Intraoperative monitoring of motor-evoked potentials using transcranial magnetic stimulation does not meet Blue Cross and Blue Shield of Alabama s medical criteria for coverage and is considered investigational.