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Billing for 95940 + 94941/G0453 (1 physician remote, 1 tech in person)

Joshua Posted Thu 16th of April, 2020 10:11:59 AM
If a company has one remote reading Physician, and one Technician "on-site", can that company bill for both the remote and in-person CPTs? In other words, can the company bill 95940 (Global) and 95941 (also Global) if there are only 1 physician and 1 technician on the case...the physician monitoring remotely.
SuperCoder Answered Fri 17th of April, 2020 11:01:48 AM

Hello Joshua,

Thank you for your question.

 

In CPT® code 95940, a provider other than the surgeon or anesthesia staff conducts neurophysiology tests, such as electroncephalography or EEG, electromyography or EMG, evoked potentials or nerve conduction study, to continuously monitor the patient during the same session as a separately reportable brain surgery. The monitoring is done from within the operating room in a one-on-one setting.

 

CPT® code 95941 may not be used for Medicare beneficiaries because it allows a provider to remotely monitor several patients at the same time. However, CMS now allows a provider to monitor only one patient at a time, so G0453 is used for continuous remote monitoring for one patient (outside the operating room).

 

Also, per Medicare Fee Schedule, the code status of this code is “I”, which means “Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services”.

Note: Kindly contact your commercial payers for specific payment information on intraoperative monitoring.

 

Now, as per your provided documentation, appropriate code will be G0453. This code covers continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient.

 

In G0453, continuous neurophysiology monitoring reduces the risk of damage to the patient’s nervous system during an operative procedure. A qualified technologist, typically under the supervision of a physiologist or neurologist, specialist physician providers, records neurophysiologic signals through various types of electrophysiologic modalities, such as somatosensory evoked potentials, which measure signals from specific nerves. The provider should document the duration of monitoring, information regarding the benefits of monitoring during the surgical procedure, and the location of the monitoring provider during the procedure, whether nearby or remote.

 

Note: Because G0453 is an add on code, payers will not reimburse you if you report it without an appropriate primary code for the operative procedure that required this monitoring.

 

Hope that helps!

Thanks

Joshua Posted Mon 20th of April, 2020 07:02:49 AM
If 1 tech is present in the Operating room, with the Physician reading from a remote location, can the company bill for both the PRO (95941 or G0453 depending on payer AND CPT 95940. In this scenario, there is 1 doctor and 1 technician. Can the company bill for both the in-person and Remote codes? I understand these are Global codes.
Joshua Posted Mon 20th of April, 2020 07:04:13 AM
This is also not a Medicare question...CPT 95941 is valid for Commercial carriers (with exception of those requiring RVU valuation)
SuperCoder Answered Tue 21st of April, 2020 10:07:36 AM

Hello Joshua,

Thank you for your additional query.

 

If 1 tech is present in the Operating room, with the Physician reading from a remote location, then only professional component is billable. As CMS established a HCPCS G code for reporting physician monitoring performed from outside of the operating room (nearby or remotely). This code is billed only for undivided attention by the monitoring physician to a single beneficiary and not for simultaneous attention by the monitoring physician to more than one.

 

Physicians cannot bill insurers for the professional component of monitoring performed by OR technicians, nurses, or other professionals employed by the hospital. In addition, physicians cannot bill insurers for the professional component of monitoring performed by others employed by the physician, including nurses or physician assistants.

 

If the hospital provides the technical component of the IOM service or pays an outsourced Provider for the technical service, the hospital may seek reimbursement for technical component provided by technician in person.

 

Furthermore, these are global reimbursement codes, not split into technical and professional components, with no mechanism to pay technologists independent of professional oversight.

 

Note: Several payers do not reimburse separately for the technical component. It is advised to get in touch with your payer for specific reimbursement guidelines/ or policy on intraoperative neurophysiology monitoring; if any.

 

Hope that helps!

Thanks

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