Download: 2016 ProPep® Coding Guide
|CPT Code||Descriptor 1||2016 Relative Value Unit (RVU)2||2016 National Medicare Facility Physician Fee Schedule2||Hospital Inpatient Payment|
|+95940||Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code of primary procedure)||.93||$33||Included in DRG payment|
|+95941||Continuous intraoperative neurophysiology monitoring from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code of primary procedure)||N/A||N/A||Included in DRG payment|
|+G0453||Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes. (List separately in addition to code of primary procedure)||.93||$33||Included in DRG payment|
|95907||1-2 nerve conduction study||2.66||$95||Included in DRG payment|
|517853||Needle electromyography studies (EMG) of anal or urethral sphincter, any technique||7.48||$268||Included in DRG payment|
2 CMS 2016 Final Physician Fee Schedule. CMS-1631-FC. Medicare physician fee schedules are facility site of service and national averages without geographically adjustment.
3 CCI edits may prevent separate payment when CPT code 51785 is billed with 95940, G0453 or 95907.
Q: What monitoring codes would typically be used during prostatectomy surgery?
A: CPT codes 95940, 95941 or G0453 are add-on codes and must be billed with the primary nerve conduction code.
Q: Can CPT code 51795 be billed for EMG of urethral sphincter performed during prostatectomy?
A: Verify directly with payer, but no coding edit (CCI edit) precludes billing 51795 with prostatectomy. However, coding edits may prevent separate payment when CPT code 51785 is billed with 95940, G0453 or 95907.
Q: Do payers cover use of ProPep® Nerve Monitoring during prostatectomy surgery?
A: Coverage decisions for IOM during prostatectomy surgery may vary so providers should verify directly with payers.
Q: Is there a HCPCS code for the ProPep® Nerve Monitoring supply?
A: There is no specific HCPCS code for the ProPep® Nerve Monitoring supply. Verify with payer if HCPCS code A4649 (surgical supply, miscellaneous) could be used for individual consideration or patient pay option.
Q: What codes would typically be billed for nerve identification during prostatectomy surgery?
A: For nerve identification during prostate surgery, typical CPT codes billed would be 95907 (nerve conduction velocity) or 51785 (anal/urethral sphincter EMG).
Q: How do I describe the nerve identification process during prostatectomy?
- A1: If nerve identification was performed prior to and/or after the pedicle dissection – Nerve identification was performed during this surgery by placing recording electrodes in the levator muscles in the pelvic floor. The perineal branches of the pudendal nerve were stimulated and the locations of these nerves were identified from the apex of the prostate to the base. Corresponding compound motor action potentials were elicited and documented and allowed for real-time evaluation of these nerves.
- A2: If nerve identification was performed prior to and/or after Apical dissection – the recording electrodes were placed directly into the External Urethral Sphincter and stimulation around the periphery of the urethral sphincter allowed for identification of the branch(es) of the nerve innervating the external Urethral Sphincter.
Q: What ICD-10 diagnosis codes would I use if patient has urinary retention or frequency prior to surgery?
A: Experience to date indicates surgeons typically document one of the following diagnosis if applicable.
|ICD 9||ICD 10|
|788.20||Retention of urine, unspecified R33.9 – Retention of urine, unspecified|
|788.21||Incomplete bladder emptying R39.14 – Feeling of incomplete bladder emptying|
|788.30||Urinary incontinence, unspecified R32. – Unspecified urinary incontinence|
|788.41||Urinary frequency R35.0 – Frequency of micturition|
|788.63||Urgency of urination R39.15 – Urgency of urination|
Hospital Inpatient Payment
Medicare reimburses hospital inpatient services under the DRG payment system, which is an all-inclusive payment. Hospitals assign ICD-10 procedure and diagnosis codes for inpatient stays. Typical DRG assignment for prostatectomy surgery would be DRG 707 or DRG 708. 2016 Medicare national payment rate for DRG 707 is $10,485 and DRG 708 is $7,764