Eleen Posted Tue 20th of December, 2016 08:35:36 AM
How would this be coded? The physician has 95938, 95955 and G0453(95941). However, there is an edit stating 95955 and G0453 have an unbundled relationship. How would this be coded? Looks like you can only do one or the other. Would it be 95955 for intraoperative monitoring for nonintracranial surgery? Thanks in advance
Surgical procedure: Left carotid endarterectomy, standard technique, bovine patch angioplasty, utilizing Sundt shunt.
Diagnosis: Left internal carotid artery critical stenosis, symptomatic, recent TIA Total monitoring hours: three and 3/4 Technician: RC Technical procedure:
EEG and SSEP monitoring was requested by the surgical team for this patient with a diagnosis as above. I reviewed and interpreted three and 3/4 hours of intraoperative monitoring for this case as requested by the surgeon. I was present by means of real time monitoring or physically in attendance in the OR.
Scalp EEG was recorded using subdermal electrodes and recorded via Cadwell Cascade system. Somatosensory evoked potentials (SSEPs) were performed to assess the functioning of the central and proximal portions of the sensory pathways. The median nerve was stimulated at the level of the wrist at intensities ranging from 20 – 35 mA. The posterior tibial nerve was stimulated at the level of the medial malleolus at intensities ranging from 40 – 65 mA. Stimulation was performed using 0.40mm diameter disposable subdermal needles. Stimulation duration was 0.1 – 0.3 mSec, frequency 2.7 – 4.7 Hz, with averaging 500 - 1000 trials per response. Cortical and subcortical responses were recorded with the Cadwell Cascade Mobile Cart Based IOM System.
Intraoperative EEG recording revealed normal symmetric rhythms at the onset of procedure, consisting of generalized slowing in the theta-delta frequency ranges, intermixed with faster activity in the 16 to 20 Hertz frequency. There was no evidence of seizure activity or asymmetry seen by the end of the record.
Baseline median and tibial SSEPs were recorded prior to incision and were symmetric and reproducible. Surgical team was notified of these findings. Intra-operative monitoring of both the median and posterior tibial nerve SSEPs were all consistent with integrity of the sensory pathways bilaterally from the median nerves at the wrist and the posterior tibial nerves at the ankle to the somatosensory cortex via the dorsal column-lemniscal pathways during and after completion of the surgical procedure. The surgeon was notified of artifact at C$ but all signals remained stable. (The electrode and impedance were checked by the technologist at the time)
The results of intra-operative EEG and SSEP monitoring are consistent with maintenance of normal cerebral function during and after completion of the surgical procedure.. No evidence of focal or global ischemia or epileptiform activity was seen at any point during the recording.
SuperCoder Answered Wed 21st of December, 2016 02:42:14 AM
Intraoperative neurophysiology testing (HCPCS/CPT codes 95940, 95941/G0453) should not be reported by the physician performing an operative or anesthesia. However, when performed by a different physician during the procedure, it is separately reportable.
AAE does not provide coding for operative reports and chart notes.
SuperCoder offers SuperCoding on Demand (SOD) (http://www.supercoder.com/coding-answers/coding-on-demand) for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail email@example.com for more information.