Highmark Medical Policy Bulletin |
Section: | Diagnostic Medical |
Number: | M-13 |
Topic: | Neurophysiological Studies |
Effective Date: | November 3, 2008 |
Issued Date: | November 17, 2008 |
Date Last Reviewed: | 08/2008 |
Indications and Limitations of Coverage
Neurophysiological studies may be reimbursed individually whether performed independently or in conjunction with each other. However, if a provider reports any neurophysiological studies (92586, 92589, 95812, 95813, 95816, 95819, 95822, 95827, 95925, 95926, 95927, 95928, 95929, 95930, 95950, 95951, 95954, 95956) in addition to comprehensive evoked response audiometry (92585), the charges should be combined and processed under code 92585 (e.g., 92585 + 92589 = 92585). Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines. Magnetoencephalography and Magnetic Source Imaging
*Medically refractory epilepsy refers to the failure of adequate trials of different classes of FDA approved antiepilepsy medications to control seizure activity, when taken in appropriate doses and carefully monitored for effectiveness and patient compliance. MEG/MSI is also considered eligible for use in presurgical functional brain mapping (PSFBM) (96020) for the preoperative evaluation of intracranial lesions located near the eloquent cortex or essential functional areas of the brain. Other uses of MEG/MSI are considered experimental/investigational, and are not covered. A participating, preferred, or network provider can bill the member for the denied service. Intraoperative Neurophysiology Monitoring Intraoperative neurophysiology monitoring is an eligible service when it is performed by an eligible professional provider for any of the following indications:
Individual consideration may be given for indications other than those above. The physician must be performing the service in real time. The physician may be in the O.R. suite or at a remote site with the monitoring performed via digital transmission or closed circuit television. When digital transmission or closed circuit television is used, there must be the ability for continuous or immediate contact with the operating surgeon to ensure that information about the patient's status can be immediately communicated. Description Neurophysiological studies is a generic term for objective tests performed via sophisticated electronic equipment to detect various neurological dysfunctions. They include the following studies:
(The above codes represent testing performed in a nonoperative setting.) NOTE: Evoked response audiometry (92585, 92586) can also be reported as:
Magnetoencephalography MEG and MSI have been found to be useful in the anatomical localization of areas of seizure focus and epileptogenic lesions of the brain, and in predicting outcomes in surgical resections for intractable temporal lobe epilepsy and brain lesions. The primary advantage of MSI is that while the conductivity and thus measurement of electrical activity as recorded by the EEG is altered by surrounding brain structures, the magnetic fields are not. Therefore, MSI permits a high resolution functional/anatomic image. This allows precise localization of epileptiform activity and anatomical identification of brain lesions. Use of MEG/MSI in presurgical functional brain mapping (PSFBM) helps to determine whether surgical resection of a brain lesion is feasible, and improves the safety and accuracy of tumor resection while reducing the risk of postoperative functional deficits. Intraoperative Neurophysiology Monitoring |
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92585 | 92586 | 92589 | 95812 | 95813 | 95816 |
95819 | 95822 | 95827 | 95920 | 95925 | 95926 |
95927 | 95928 | 95929 | 95930 | 95950 | 95951 |
95954 | 95956 | 95965 | 95966 | 95967 | 96020 |
S8035 |
Traditional (UCR/Fee Schedule) Guidelines
This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits are determined by the Federal Employee Program. |
Comprehensive / Wraparound / PPO / Major Medical Guidelines
Any reference in this bulletin to non-billable services by a network provider may not be applicable to Major Medical.
Managed Care (HMO/POS) Guidelines
PRN References 03/1994, Intraoperative neurophysiology testing, coding for |
Epilepsy Surgery, Resection Volume and MSI Localization in Lesional Frontal Lobe Epilepsy, Elsevier Ireland, Ltd., 08/2003 Magnetoencephalography (MEG) Predicts Focal Epileptogenicity in Cavarnomas, The Journal of Neurology, Neurosurgery and Psychiatry, 2004 Does Magnetoencephalography Add to Scalp Video-EEG as a Diagnostic Tool in Epilepsy Surgery? Neurology, Volume 62, 03/2004 Magnetoencephalography Source Localization and Surgical Outcome in Temporal Lobe Epilepsy, Elsevier Ireland, Ltd, 06/2004 Application of Magnetoencephalography in Epilepsy Patients with Widespread Spike or Slow-wave Activity, Epilepsia, Volume 46, Number 8, 2005 Detection of Epileptiform Activity by Human Interpreters: Blinded Comparison Between Electroencephalography and Magnetoencephalography, Epilepsia, Volume 46, Number 1, 2005 Dynamic Statistical Parametric Mapping for Analyzing the Magnetoencephalographic Epileptiform Activity in Patients with Epilepsy, Journal of Child Neurology, Volume 20, 04/2005 Toward the Substitution of Invasive Electroencephalography in Epilepsy Surgery, The Journal of Clinical Neurophysiology, Volume 22, Number 4, 08/2005 Magnetic Source Imaging Localizes Epileptogenic Zone in Children with Tuberous Sclerosis Complex, Neurology, Volume 66, 04/2006 Reliability of Language Mapping with Magnetic Source Imaging in Epilepsy Surgery Candidates, Elsevier Ireland, Ltd, 04/2006 Magnetoencephalography/Magnetic Source Imaging, MPRM, Policy 6.01.21, 12/12/2006 Kakigi R, Hoshiyama M, Shimojo M, Naka D, Yamasaki H, Watanabe S, Xiang J, Maeda K, Lam K, Itomi K, Nakamura A. The somatosensory evoked magnetic fields. Progress in Neurobiology. 1999:61:495-523. Albertstone CD, Skirboll SL, Benzel EC, Sanders JA, Hart BL, Baldwin NG, Tessman CL, Davis JT, Lee RR. Magnetic source imaging and brain surgery: presurgical and intraoperative planning in 26 patients. Journal of Neurosurgery. 2000;92:79-90. Oishi M, Fukuda M, Kameyama S, Kawaguchi T, Masuda H, Tanaka R. Magnetoencephalographic representation of the sensorimotor hand area in cases of intracerebral tumor. Journal of Neurology, Neurosurgery, and Psychiatry. 2003;74:1649-1654. Papanicolaou AC, Simos PG, Castillo EM, Billingsley RL, Buchanan S, Wheless J, Maggio V, Maggio WW. Magnetoencephalography: a noninvasive alternative to the wada procedure. Journal of Neurosurgery. 2004;100:867-76. Ganslandt O, Buchfelder M, Hastreiter P, Grummich P, Fahlbusch R, Nimsky C. Magnetic source imaging supports clinical decision making in glioma patients. Clinical Neurology and Neurosurgery. 2004;107:20-26. Grover KM, Bowyer SM, Rock ML, Rosenblum KM, Moran JE, Smith BJ, Barkley GL. Retrospective review of MEG visual evoked hemifield responses prior to resection of temporo-parieto-occipital lesions. Journal of Neuro-Oncology. 2005. Makela J, Forss N, Jaaskelainen J, Kirveskari E, Korvenoja A, Paetau R. Magnetoencephalography in neurosurgery. Neurosurgery. 2006;59:493-511. Grummich P, Nimsky C, Pauli E, Buchfelder M, Ganslandt O. Combining fMRI and MEG increases the reliability of pre-surgical language localization: a clinical study of the difference between and congruence of both modalities. Neuroimage. 2006;32:1793-1803. Korvenoja A, Kirveskari, Aronen HJ, Avikainen S, Brander A Huttunen J, Ilmoniemi RJ, Jaaskelainen JE, Kovala T, Makela JP, Salli E, Seppa M. Sensorimotor cortex localization: comparison of magnetoencephalography, functional MR imaging, and intraoperative cortical mapping. Radiology. 2006;241:213-22. Kamada K, Sawamura Y, Takeuchi F, Kuriki S, Kawai K, Morita A, Todo T. Expressive and receptive language areas determined by a non-invasive reliable method using functional magnetic resonance imaging and magnetoencephalography. www.neurosurgery-online.com. 2007;60:296-306. Larsen S, Kikinis R, Talos IF, Weinstein D, Wells W, Golby A. Quantitative comparison of functional MRI and direct electrocortical stimulation for functional mapping. International Journal of Medical Robotics and Computer-Assisted Surgery. 2007;3:262-70. Stippich C, Rapps N, Dreyhaupt J, Durst A, Kress B, Nennig E, Tronnier VM, Sartor K. Localizing and lateralizing language in patients with brain tumors: feasibility of routine preoperative functional MR imaging in 81 consecutive patients. Radiology. 2007;243:828-36. Tharin S, Golby A. Functional brain mapping and its applications to neurosurgery. Neurosurgery. 2007;60:185-201. Chakraborty A, McEvoy AW. Presurgical functional mapping with functional MRI. Current Opinion Neurology. 2008;24:446-51. Bizzi A, Blasi V, Falini A, Ferroli P, Cadioli M, Danesi U, Aquino D, Marras C, Caldiroli D, Broggi G. Presurgical functional MR imaging of language and motor functions: validation with intraoperative electrocortical mapping. Radiology. 2008;248:579-89. |