Fallacies of Remote Neuromonitoring:- a Realist Perception
....coming up.....! Oct 2011
There are various issues, policies and guidelines with regard to remote monitoring are kind of cloudy. Mostly done by trained neurologists, I am not sure how many PhDs or D-ABNMs are doing remote monitoring. I am not sure how and who initiated this remote monitoring but is not same as the Intraoperative neuromonitoring where the Neurophysiologist/or tech or physician conducting neuromonitoring will be present and actively collecting data, analyzing and interpreting in addition to keeping consistent Data.
In terms of helping out the surgeon during crisis or iatrogenic damages caused during surgical procedure, the most appropriate way is to physically present in the OR and discuss the issues with surgeon, provide interpretation of what is happening to the patient and how to go about in protecting the patient from further damage.
In the remote, a physician watching either one or many monitor will interact on a messenger or remote software or perhaps on the mobile phone with a tech inside the OR, not sure how and what they do during a crisis, the guidelines suggests physical presence of the remote monitoring professional in the vicinity within the same building and other mode of conducting neuromonitoring in a remote place is for the time being going on ?. How long this will go without proper streamlining, no body knows, I am sure there is quite a bit of discussion is ongoing with the neuromonitoring society?
As far as to how many cases a remote monitor can do simultaneously is questionable too. The Medicare rules guidelines will only allow one surgery remotely monitored at a time, not more than one. Whereas, private insurance providers, may or may not adhere to this medicare policy, remote monitoring individual can monitor more than case in non-medicare providers???.
Also note that in medicare cases, anesthesiologist or surgeon can't use the code?.
Intraoperative Monitoring (95920)
Q: How do I account for the time appropriately when billing code 95920 (intraoperative testing)?
A: This code is billed along with the code for the particular evoked potential or other neurodiagnostic test that is being performed intraoperatively. The evoked potential code or other procedure code covers the usual baseline test time of 20–60 minutes and one adds one unit of code 95920 for each additional 60 minutes of monitoring beyond what is normally done.
These questions should be asked less frequently now that the definition of this code has been revised to include more details on how it is to be used. Code 95920 is set up so that the typical use is one in which the physician is present in the room monitoring one patient. Being in the room is not absolutely mandatory, however. Note that the local Medicare carriers that allow off-site monitoring ask that there be one-on-one attention paid to that patient when monitored at a distance. In that setting, having one physician watch lots of rooms is not what the code was meant for—at least that's not what the reimbursement rate was set up to reflect. Furthermore, the anesthesiologist or the surgeon who is doing the case cannot use the code. There is variability among payers: some other carriers other than Medicare may permit one physician to monitor multiple patients.
Regardless of the location of the monitoring physician, modifier 26 would always be used when reporting these services.
