Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Stimulation Mapping

Luz Posted Thu 17th of March, 2016 14:29:38 PM

I need your help again. I have raised this question to you before and you suggested CPT code 95961, and I agree. However, what I did not stated was that this service is done between three providers as stated below:
For intra-operative mapping:
Surgeon controls the stimulator
Neurologist reads the EEG
Neuropsychologist conducts testing directly with the patient

For extra-operative mapping
Neurologist – controls stimulator and reads EEG
Neuropsychologist conducts testing directly with the patient

My question is- what CPT code would be appropriate to bill for each, Neurologist service, the Neuropsychologist service; and the surgeon service.

Thank you so much, for your expert advice;its appreciated.

See description of procedure below:

Cortical stimulation mapping is an invasive procedure in which electrical stimulation is applied briefly to the cortex for the purpose of identifying areas critical for sensory, motor or language function. This procedure is utilized when brain surgery involves the removal or disruption of potentially functional brain areas. Sites identified via stimulation mapping are typically spared from resection, with the goal of preserving function postoperatively.

The procedure can be conducted intra-operatively (i.e., in the operating room) in a conscious patient before removal of brain tissue, or extra-operatively in the patient’s hospital room, if subdural electrodes have already been surgically implanted in the brain (most commonly in pharmacologically resistant epilepsy patients who require intracranial EEG monitoring to determine the region of seizure onset and spread).
The identification of language areas in the brain requires detailed language testing during stimulation of multiple cortical/brain sites, one or two electrode sites at a time, for several seconds at a time. The patient must be engaged in a language task and stimulation of language cortex will disrupt task performance. Thus, stimulation produces a discrete, reversible lesion, enabling the examiner to observe the functional consequences of damage to the area that is stimulated. Because language areas are functionally specific, it is best to conduct different types of language testing at each brain site being evaluated (e.g., comprehension, reading, naming, etc).

SuperCoder Answered Fri 18th of March, 2016 09:33:21 AM

Our expert team is working on this. We will get back to you soon.

SuperCoder Answered Fri 18th of March, 2016 10:54:32 AM

This code is payable to a physician or other qualified health care professional. 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. Only the physician or other qualified health care professional can bill for the services.

Luz Posted Fri 18th of March, 2016 14:44:47 PM

I hope you don't mind if it still have questions. The surgeon can not bill because is included in the global package-understood. But,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? Thank you.

SuperCoder Answered Mon 21st of March, 2016 02:56:57 AM

LUZ, you can always ask questions till you are satisfied.

CPT code 95961 is payable to a physician OR other qualified health care professional. Both neurologist and Neuropsychologist are not required for the procedure. This procedure requires attendance by a physician OR other qualified health care professional. If the physician or health care professional has only read EEG, then submit the code with 26 modifier, If the provider has provided only the technical services, append TC modifier to the code and if both the professional and technical services have been provided, then submit the global code without any modifier.

CPT code 96118 can not 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.

Related Topics