Answer: It depends on the insurer.
Usual way: Medicare only pays for nerve monitoring when performed by a surgeon who is not performing the main operation. You indicate that the otolaryngologist performs both the facial nerve monitoring and the total thyroidectomy. So for Medicare, bill only the surgery with 60240 (Thyroidectomy, total or complete).
Rare exceptions: But some private payers allow the operating surgeon to also bill for facial nerve monitoring. When reporting intraoperative facial nerve monitoring, you-ll need to use three codes -- one for the primary procedure (the surgery), one for the electrophysiologic study that accompanies the surgery, and one for the monitoring itself.
For the above scenario, report for the:
1. total thyroidectomy 60240
2. professional component of the bilateral study 95868-26 (Needle electromyography; cranial nerve supplied muscles, bilateral; Professional component)
3. monitoring two units of +95920-26 (Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]). Modifier 26 on the study and monitoring codes indicates the physician does not own the equipment and is billing only the professional component.