AAN Publishes Guideline and Model Medical Policy on Intraoperative Monitoring

February 20, 2012

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Intraoperative monitoring (IOM) of patients during spinal surgery and certain chest surgeries is the topic of an updated AAN evidence-based guideline.

"Evidence-based Guideline Update: Intraoperative Spinal Monitoring with Somatosensory and Transcranial Electrical Motor Evoked Potentials" was published simultaneously in Neurology® and in the Journal of Clinical Neurophysiology on February 21, 2012.

According to the guideline, strong evidence shows monitoring the spinal cord during spinal surgery and some chest surgeries, including those performed to repair coarctation of the aorta, can help prevent paralysis related to surgery. This monitoring can alert the surgeon in time to find and address the problem before damage occurs.

IOM of the spinal cord most likely would include monitoring of somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) so that both sensory and motor modalities are evaluated. Transcranial electrical MEP more directly monitors the motor pathway itself. In the operating room, transcranial electrical stimulation is the most reliable current measure of motor tract function.

Several public and private payers reached out to the AAN for guidance due to an apparent increase in use and possible misuse of CPT code 95920 [Intraoperative neurophysiology testing, per hour (List separately in addition to code for primary procedure)].

The Academy updated its model medical policy to help payers and AAN members define appropriate use of IOM services.

The policy, available at www.aan.com/go/practice/policy, includes:

  • Background on IOM
  • Citations of published literature, including the updated AAN guideline, that demonstrate the usefulness of IOM in averting neural injuries during surgery
  • Specific coding instructions for use of 95920
  • A nonexclusive list of medically necessary diagnoses

Read the Model Medical Policy (.pdf)

Read the guideline and access PDF summaries for clinicians and patients, a slide presentation, and a clinical example.

For more information, contact Julie Cox at jcox@aan.com or (651) 332-8684.