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Stimulation-based Functional Cortical and Subcortical Mapping

David Perry Posted Fri 18th of November, 2016 21:04:05 PM
The answers to Luz regarding how to bill CPT code 95961 were extremely helpful, but left me with more questions. As she described, stimulation mapping can involve different teams depending on context (e.g. intraoperative-direct cortical/subcortical vs. extraoperative-via implanted grid) and it’s not clear to me how to divide the “professional” and “technical” components in any of these situations. In her case: For intra-operative mapping: 1. Surgeon controls the stimulator 2. Neurologist reads the EEG 3. Neuropsychologist conducts testing directly with the patient For extra-operative mapping: 1. Neurologist – controls stimulator and reads EEG 2. Neuropsychologist conducts testing directly with the patient She asked what CPT code would be appropriate to bill for each: Neurologist service, the Neuropsychologist service; and the surgeon service. What CPT code do we bill for the Neuropsychologist service, (Neuropsychologist conducts testing directly with the patient) AND what CPT code do we bill for the Neurologist (the neurologist controls stimulator and reads EEG)- how do we bill for the service of these two providers- when done to the same patient, same date of service and same session. What CPT code is appropriate for their services. Is it appropriate to bill 95961, 95951 for the Neurologist service and 96118 for the Neuropsychologist service? Your answer was in summary: 1. Surgeons do not bill for this code since the service will be included in the global charges of the procedure (surgery) which the surgeon is performing. 2. If the physician or health care professional has only read EEG, then submit the code with 26 modifier. 3. If the provider has provided only the technical services, append TC modifier to the code 4. If both the professional and technical services have been provided, then submit the global code without any modifier. 5. CPT code 96118 cannot be billed since the code requires performing Neuropsychological testing like Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test, which were not performed on the day of the procedure. Questions for me about this answer are: 1. Reading EEG is not an essential part of functional mapping by stimulation (when stimulation disruption, not EEG is the criterion for mapping). Stimulation mapping can be performed without EEG. Unless trying to localize seizure focus, a different procedure, EEG is monitored only to detect seizures that can develop as a side-effect of the current. Many centers perform stimulation mapping if function without EEG. At our institution, for non-seizure mapping cases, the neurologist monitors EEG for seizure activity only during the initial period of mapping (cortical surface prior to excision). Stimulation mapping continues throughout the procedure, cortical and subcortical. 2. The surgeon cannot control the stimulator current directly because it is not sterile. He controls the movement of the probe and the application of current to the brain of course, and selects the sites for testing. A biotechnician employed by the hospital manipulates the dial for current level on the hospital-owned stimulator at the surgeon’s direction (i.e. a low level technician, not another health care provider). 3. The neuropsychologist operates a computer to present language and cognitive tasks to the patient, recording and analyzing responses and delivering results to the surgeon in real time. 4. In extraoperative mapping, the neurologist controls the level and location of current to the implanted grid, and can also monitor EEG for seizures (combining the functions in 1 and 2 above). (3) remains the same. Therefore what would be the appropriate use of 95961 be in the intraoperative case? What exactly is the technical component of stimulation mapping? It’s not EEG in this context - that should probably be a separate procedure (e.g. electrocorticography?). Is TC the delivery of current itself? Or could it be running the computer for language/cognitive functional testing? Is the professional component the interpretation of the stimulation results by the neuropsychologist to the neurosurgeon? 1. Could the neuropsychologist bill 95961 with no modifier in this situation? Or should it be 95961-26? 2. Should 95961-TC be billed for the delivery of current? Or in this situation is that included in the global charges of the procedure (surgery) which the surgeon is performing global and not billable separately? 3. Could the computer delivery of tasks to the patient for mapping be billable as 95961-TC? 4. Should 96118 be revisited, acknowledging that the language and cognitive tasks presented to the patient are in themselves standardized neuropsychological tests (though developed locally, by the institution)? Many thanks for your help with these to me complex questions! -David
SuperCoder Answered Mon 21st of November, 2016 08:37:06 AM

Hi,

Our team is working on the query and will get back to you soon.

SuperCoder Answered Mon 21st of November, 2016 08:45:55 AM

Hi, Our team is working on the query and will get back to you soon.

SuperCoder Answered Mon 21st of November, 2016 08:45:55 AM
Hi, Our team is working on the query and will get back to you soon.
SuperCoder Answered Tue 22nd of November, 2016 04:42:01 AM

Hi,

If the provider is reporting only the professional component for the service, append professional component modifier 26 to the code. 

If provider is reporting only the technical component for the service, append technical component modifier TC to the code unless the hospital provided the technical component. In that case, do not append modifier TC because the hospital’s portion is inherently technical.

 Do not append a professional or technical modifier to the code when reporting a global service in which one provider renders both the professional and technical components.

There is no separate payment for Physician, surgeon and Neuropsychologist. The code descriptor clearly suggest that the services are being provided by a physician or health care professional. For interpretation of result, 26 modifier should be given to physician (neurologist) and the one that provides the technical services (facility) will get TC benefits.

For global services, need not to bill a modifier and providers (surgeon, neurologist, neuropsychologist) can claim for their services from the facility.

Hope this helps.

SuperCoder Answered Tue 22nd of November, 2016 04:42:02 AM

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