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Carotid Endarterectomy Coding

Joshua Posted Mon 08th of June, 2020 10:56:29 AM
How would you properly code a Carotid Endarterectomy during Intraoperative Neuromonitoring?
SuperCoder Answered Tue 09th of June, 2020 03:30:13 AM

Thank you for your question.



CPT® code 35301 (Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision) seems appropriate for the Carotid Endarterectomy. CPT® code 95940 and 95941/G0453 used for intraoperative neuromonitoring.


The surgery performing physician cannot bill for 95940 and 95941. But if these services provided by some other physician, then he/she can bill for them.


As per NCCI statement, ''Intraoperative neurophysiology testing (HCPCS/CPT codes 95940, 95941/G0453) shall not be reported by the physician performing an operative or anesthesia procedure since it is included in the global package. However, when performed by a different physician during the procedure, it is separately reportable by the second physician. The physician performing an operative procedure shall not report other 90000 neurophysiology testing codes for intraoperative neurophysiology testing (e.g., 92585, 95822, 95860-95870, 95907-95913, 95925, 95926, 95927, 95928, 95929, 95930-95937, 95938, 95939) since they are also included in the global package''.



Note: Because 95940/95941/G0453 are 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!



Joshua Posted Tue 09th of June, 2020 06:04:25 AM
CPT® code 35301? We are not performing the surgery... Only the neuromonitoring and EEG services. The question from the clinician was whether CPT 95955 or 95822 was appropriate.
SuperCoder Answered Wed 10th of June, 2020 03:45:49 AM

Thank you for your question!


CPT® code 35301 was suggested as per the initial query as How would you properly code a Carotid Endarterectomy procedure.  CPT® code 95955 and 95822 are used when EEG services were performed. If the EEG service was performed during Carotid Endarterectomy then CPT® code 95955 [Electroencephalogram (EEG) during non-intracranial surgery (eg, carotid surgery)] would be appropriate to code instead of 95822. As CPT® code 95822 is used when Electroencephalogram (EEG); recording in coma or sleep only.



Hope that Helps!

Joshua Posted Wed 10th of June, 2020 05:50:23 AM
When would CPT 95822 be appropriate? If the patient is not in a coma, but is under Anesthesia during surgery - would 95822 be appropriate? Currently; we are billing 95955 for non-intra cranial and 95819 for intracranial. Would 95822 be more appropriate?
Joshua Posted Wed 10th of June, 2020 05:51:18 AM
When would 95822 be used?
SuperCoder Answered Thu 11th of June, 2020 02:39:24 AM

Thank you for your question


   If the patient is not in a coma, but is under Anesthesia during surgery - would 95822 be appropriate? No, It would not be appropriate to code 95822 in this scenario. Above provided documentation doesn’t state anywhere that patient was in coma, but was under influence of anaesthesia for carotid surgery, so reporting 95822 would not be appropriate as this code is reportable when the patient is in coma or sleep state.


Use this code 95822 when the provider performs the electroencephalogram when the patient is in a state of coma or sleep. For a patient in the coma state, the goal is to identify the early signs of recovery and to establish the prognosis for the coma patient. For a patient in sleep to evaluate other brain disorders for further treatment and signs of recovery by recording brain activity during sleep.


Hope that Helps!

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