Coding for Intraoperative Neurophysiology Testing

Q: What is Intraoperative Neurophysiology Testing and can I bill for it?

A: This "add-on" code, CPT 95920 Intraoperative Neurophysiology testing, per hour (List separately in addition to code for primary procedure), is frequently called "nerve monitoring". Physicians use this CPT code when performing nerve monitoring during complex surgical procedures involving cranial nerves. Another physician (usually a neurologist or physiatrist), or an electrodiagnostic technologist prepares the patient prior to surgery by attaching fine wires and electrodes on designated areas, such as the face or neck during case of facial nerve monitoring. For recurrent nerve monitoring, the electrodes are integrated into the endotracheal tube. These electrodes are connected to electrodiagnostic equipment that monitors specific nerves either through automated monitoring (e.g., an audible alarm) or by the clinician’s interpretation of the monitoring device's output.

The American Medical Association’s Current Procedural Terminology (CPT®) does not limit CPT codes to any particular specialty. Therefore, otolaryngologists may bill intra-operative neurophysiology testing, using CPT code 95920 if this represents the physician’s work. The operating surgeon must request the test and a physician other than the operating surgeon or the assistant surgeon would need to perform the nerve monitoring. It is not appropriate to append modifier 51 (multiple procedures) to CPT code 95920 when nerve monitoring is performed on multiple nerves. CPT code 95920 is not billable as a stand-alone code.  According to the CPT® manual, “Code 95920 is reported per hour of service, and includes only the ongoing electrophysiologic monitoring time distinct from performance of specific type(s) of baseline electrophysiologic study(s) (95860, 95861, 95867, 95868, 95870, 95900, 95904, 95928, 95929, 95933-95937) or interpretation of specific type(s) of baseline electrophysiologic study(s) (92585, 95822, 95870, 95925-95928, 95929, 95930). The time spent performing or interpreting the baseline electrophysiologic study(s) should not be counted as intraoperative monitoring, but represents separately reportable procedures.”

For example, if facial nerve monitoring is performed during a parotidectomy, link CPT code 95920 with the appropriate EMG CPT code (95867 - Needle electromyography; cranial nerve supplied muscle(s), unilateral), instead of with the parotidectomy CPT code. If the physician performs only the interpretation and does not own the equipment, he or she should append modifier -26 (professional component) to the code. The provider performing the monitoring must both report the intra-operative findings and record his or her precise level of involvement to obtain reimbursement. It is best to use CPT terminology in the dictation whenever possible.The physician who performs the nerve monitoring should have appropriate credentials to guarantee reimbursement.

Many carriers consider monitoring with an automated device integral to the surgery performed and they will not reimburse for these services separately. Hence, ensure that you familiarize yourself with your contracted insurer’s medical policy and coding guidelines for this CPT code. Ultimately, it is at the discretion of the surgeon to make a decision on the mode and administration of the test. 

Reviewed May 2007

Revised June 2009