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This article clarifies supervision and coding issues regarding intraoperative monitoring (CPT Code 95920).
CPT code 95920, Intraoperative neurophysiology testing, per hour (list separately in addition to code for primary procedure).
CPT code 95920 may be used as an add-on code to a limited series of base services (92585, 95822, 95860, 95861, 95867, 95868, 95870, 95900, 95904, 95925-95937). These services include auditory evoked potentials, nerve conduction studies, EEG recording in coma or sleep, and other studies. Each of these base services, is categorized as a diagnostic test, so that each has a technical component, an interpretation component, and a supervision level (when the test is performed by a technician under the supervision of a physician). The underlying service must be clinically necessary, conducted under appropriate supervision, and must be performed and documented completely. In some cases (for example, nerve conduction studies, 95900), a Local Coverage Determination may apply to the underlying service (ref. 1).
Example:
CPT code 95822 could be used to for the EEG of an anesthetized patient.
Supervision: EEG testing, 95822, may be conducted by a physician, or an appropriate technician under general supervision. In contrast, the 95920 monitoring service is Supervision Level 22, which states "Procedure may be performed by a technician with on-line real-time contact with physician." (ref. 2).
Base Code is Performed: The full service for 95822 is performed, which takes 15 minutes.
Additional Intraoperative Monitoring: The patient is monitored by the physician for an additional 60 minutes, and one unit of code 95920 is billed. Because CPT code 95920 is a one hour timed code, it should not be billed when the additional intraoperative monitoring service (over and above the base code) is less than 29 minutes. One unit of service is, for example, between 30 minutes and one hour and 29 minutes.
CPT code 95920 may only be billed for one patient at a time. Unlike some diagnostic tests, most of the value of 95920 is the physician's component, not the technical component. CPT code 95920 has relative value units per hour which are similar to those of other 1:1 physician patient care services (e.g. inpatient prolonged services, 99357) and it is not intended to be billed for five or ten patients simultaneously. (See, e.g. ref. 3).
CPT code 95920 is not separately billable when performed by the anesthesiologist or surgeon. As an additional physician service, CPT code 95920 must be clinically necessary, e.g. necessary for patient management and not routinely performed by the anesthesiologist or surgeon.
Ref. 1 - For discussion of some of the base services, see NHIC LCD, Nervous System Studies - Autonomic Function, Nerve Conduction and Electromyography. The basic code (e.g. 95900) covers a diagnostic test of a nerve, and is billed once, even if the nerve in question (e.g. left sural nerve) is tested a few times as the diagnosis is made and electrodes are shifted. Ongoing monitoring, exceeding the base service, is billed by CPT code 95920.
Ref. 2 - Supervision of diagnostic tests is discussed in Internet-Only Manual, Pub. 100-04, Benefits Policy Manual, Chapter 15, Section 80. This section defines supervision levels (1,2,3, etc). For every diagnostic test, a supervision level is shown in the online RVU physician fee schedule file: http://www.cms.hhs.gov/PhysicianFeeSched.
Ref. 3 - See, for example, National Government Services LCD L3591, Introperative Neurophysiological Testing.
CPT code 95920, Intraoperative neurophysiology testing, per hour (list separately in addition to code for primary procedure).
CPT code 95920 may be used as an add-on code to a limited series of base services (92585, 95822, 95860, 95861, 95867, 95868, 95870, 95900, 95904, 95925-95937). These services include auditory evoked potentials, nerve conduction studies, EEG recording in coma or sleep, and other studies. Each of these base services, is categorized as a diagnostic test, so that each has a technical component, an interpretation component, and a supervision level (when the test is performed by a technician under the supervision of a physician). The underlying service must be clinically necessary, conducted under appropriate supervision, and must be performed and documented completely. In some cases (for example, nerve conduction studies, 95900), a Local Coverage Determination may apply to the underlying service (ref. 1).
Example:
CPT code 95822 could be used to for the EEG of an anesthetized patient.
Supervision: EEG testing, 95822, may be conducted by a physician, or an appropriate technician under general supervision. In contrast, the 95920 monitoring service is Supervision Level 22, which states "Procedure may be performed by a technician with on-line real-time contact with physician." (ref. 2).
Base Code is Performed: The full service for 95822 is performed, which takes 15 minutes.
Additional Intraoperative Monitoring: The patient is monitored by the physician for an additional 60 minutes, and one unit of code 95920 is billed. Because CPT code 95920 is a one hour timed code, it should not be billed when the additional intraoperative monitoring service (over and above the base code) is less than 29 minutes. One unit of service is, for example, between 30 minutes and one hour and 29 minutes.
CPT code 95920 may only be billed for one patient at a time. Unlike some diagnostic tests, most of the value of 95920 is the physician's component, not the technical component. CPT code 95920 has relative value units per hour which are similar to those of other 1:1 physician patient care services (e.g. inpatient prolonged services, 99357) and it is not intended to be billed for five or ten patients simultaneously. (See, e.g. ref. 3).
CPT code 95920 is not separately billable when performed by the anesthesiologist or surgeon. As an additional physician service, CPT code 95920 must be clinically necessary, e.g. necessary for patient management and not routinely performed by the anesthesiologist or surgeon.
Ref. 1 - For discussion of some of the base services, see NHIC LCD, Nervous System Studies - Autonomic Function, Nerve Conduction and Electromyography. The basic code (e.g. 95900) covers a diagnostic test of a nerve, and is billed once, even if the nerve in question (e.g. left sural nerve) is tested a few times as the diagnosis is made and electrodes are shifted. Ongoing monitoring, exceeding the base service, is billed by CPT code 95920.
Ref. 2 - Supervision of diagnostic tests is discussed in Internet-Only Manual, Pub. 100-04, Benefits Policy Manual, Chapter 15, Section 80. This section defines supervision levels (1,2,3, etc). For every diagnostic test, a supervision level is shown in the online RVU physician fee schedule file: http://www.cms.hhs.gov/PhysicianFeeSched.
Ref. 3 - See, for example, National Government Services LCD L3591, Introperative Neurophysiological Testing.
