Resolved Facial Nerve Monitoring

[RachelA_80432]

In an ASC facility, the surgeon has an assistant surgeon and an anesthesiologist.
The main procedure is a mass excision (42440)
The surgeon also had the assistant surgeon preform facial nerve monitoring.

To code for for an ASC facility : would i use 4244, 95868-TC? and how would i know when to add 95940?
Or is the nerve monitoring included in the main procedure?

I even thought about 92516-TC but i think that's more of a diagnostic test than a monitor test.

Help please!

And which procedures would I add the assistant surgeon modifier to? Just the nerve monitor or the main procedure as well?

My brain is starting to go in circles, Thank you.

 

[Alicia]

These are the codes you are looking at:
42440 - Excision of submandibular (submaxillary) gland
95868 - Needle electromyography; cranial nerve supplied muscles, bilateral
95940 - Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)
92516 - Facial nerve function studies (eg, electroneuronography)
I am going to have to break this down into two posts because of the word count.
As discussed in the August 2017 edition of CPT®Assistant, codes 95940 and 95941 are global (complete) services and have not been split into professional and technical component services. For this reason, modifier 26, Professional Component, and modifier TC, Technical Component, are not appropriate to report with these codes. Furthermore, as stated in the August 2017 CPT®Assistant article, the cost of clinical staff, supplies, and equipment are separately payable to the facility through a facility fee.


The following is the corrected Q&A.

Question: It is my understanding that code 95940, Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure), and code 95941, Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure), contain both a professional and technical portion of the services. Is it appropriate to append modifier 26 to codes 95940 and 95941? Is the technical portion of the testing part of the monitoring or part of the study it is associated with?

Answer: No, it is not appropriate to append modifier 26, Professional Component, to codes 95940 and 95941. In addition, it is also inappropriate to append modifier TC for the technical portion of the services. Code 95940 describes the service of providing one-on-one patient monitoring by a professional in the operating room while code 95941 describes the patient monitoring of more than one patient from a location outside the operating room. In either case, the cost of clinical staff, supplies and equipment are separately reported by the facility through a facility fee.♦

 

[Alicia]

The assistant is there to help with the main procedure. Do not over think it. Even though they do different parts, they are helping with "everything". The assistant is billed on a separate claim under his/her name. Without seeing the op report I can't say more. I hope this helps. If it doesn't let me know.

Here is a pdf on assistant surgeon modifiers you will find helpful https://www.bluecrossnc.com/content...rgeon_and_assistant_at_surgery_guidelines.pdf
Another link

Key Points to Remember for Assistant Surgeon Billing

If you take things one step at a time, you can figure out whether or not an assistant surgeon service meets the criteria to be billed for a particular service. It is a complex task, but breaking it down makes it easier to understand and in turn leads to correct, successful billing.

www.healthicity.com

 

[RachelA_80432]

My question was only from a technical side. How would an ASC facility bill facial monitoring during an mass excision (42440). I am not billing for any professional services. All i need to know is how to bill the facial monitoring from a technical stand point. I am only working with 95868 for the monitor and needed to know when i add on 95940 to add the 15 extra minutes. I am not using the 95941 that would be a different procedure since the monitoring was done inside the OR.

The assistant was monitoring the the facial monitor while the main surgeon preformed the mass excision all inside the OR room.
So i need to do two claims? One for the mass excision and one for the assistant doing the nerve monitoring?

 

[Alicia]

Yes, that would need two claims. The Assistant Surgeon is a separate. You can code the 95868 and 95940. Do not use the TC modifier.

 

[RachelA_80432]

Ok i see now, so i would use two separate claims instead of coding it as: 42440, 95868-80, 95940-TC on one claim form?

Instead, on claim 1: 42440
Then on Claim 2: 95868, 959409

To make sure I understand the reason I would not use the TC is because 95868 and 95409 are procedure codes and the technical fees would be included?

And the reason I would use two separate claim forms is because it's two different surgeons even though it's an ASC?

However, would I need two operative reports ( one from each provider)? I only have one saying the second provider assisted with the facial monitoring while he preformed the mass excision.

Thank you for your help, this has been very confusing for me and I have hit a roadblock at getting any help with this.

 

[Alicia]

You got it. No worries, you only need one op report. If you doubt they will understand send the op with both claim. You have offered such a great scenerio I am going to work it up for a future video.

 

[RachelA_80432]

Here's an update, all of it got denied except for the 42440 and I was told I should never have billed the monitoring in the first place.

 

[Alicia]

Who was the payer? What was the reason for the denial when it came in?