Neurology & Pain Management Coding Alert

Reader Question: 95920 With SSEP


- Published on Sat, Dec 01, 2001

" Question: When using 95920 with other codes, i.e., 95925 and 95926, and submitting them for interpretation, should modifier -26 be attached to each? Should the charge for the service be placed with the 95920-26 or with 95925 and 95926? Also, can multiples of 95920-26 be charged when several hours of monitoring are performed?
 
For example, a three-hour upper- and lower-extremity SSEP is performed during anterior cervical discectomy and fusion at an outside facility. Is this coded 95920-26 (x3) at $xx.00/hour, 95925 and 95926, or does each code require the -26 modifier? What if we had also performed a preoperative 95925 and 95926 in the office and also bill the global fee for these procedures?

Maryland Subscriber
Answer: Yes, modifier -26 (professional component) should be attached to each code, and yes, multiples of add-on code 95920 (intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]) may be charged for multiple hours. Modifier -26 is attached to all neurophysiological services performed in a hospital setting, and each code has its own fee, even if multiple units of the code are charged.
 
In the example provided, if both upper and lower limbs are tested, report 95925 (short-latency somatosensory evoked potential [SSEP] study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs) and 95926 ( in lower limbs) with modifier -26 appended (i.e., 95925-26, 95926 -26), as well as 95920 with modifier -26, times the number of hours of monitoring, e.g., 95920-26 x 2 for two hours of monitoring. Note that only one unit of 95925 and/or 95926 may be claimed, regardless of the number of nerves/skin sites stimulated. Note also that these are bilateral codes. Modifier -52 (reduced services) must be used to indicate a unilateral study.
 
When performing upper and lower SSEPs as a preoperative study in the office, report 95925 and 95926 with no modifier because you are billing for the total service, not the professional component alone."

Neurology & Pain Management Coding Alert
Issue - Dec, 2001
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