Documentation and Reimbursement

Intraoperative nerve monitoring (IONM) is widely accepted among otolaryngologic surgeons as a patient safety tool that allows for real-time functional assessment of cranial nerves. IONM is a separate procedure from the primary surgery and requires unique equipment and expertise in setup and use, data interpretation, and troubleshooting. Several standardization guidelines and position statements have been put forth regarding the optimal setup and use of IONM, with an argument for primary management of IONM by the operating surgeon given the potential for instantaneous adjustment of operative maneuvers to best maintain neural integrity. The surgeon also maintains primary medicolegal responsibility for patient safety and therefore has particular interest in the efficacy of neural monitoring efforts during surgery. IONM is within the scope of otolaryngologic practice and is required by the American Board of Otolaryngology – Head and Neck Surgery as a core competency for residency training. Despite growing arguments for primary control of IONM by the operating surgeon, reimbursement from the Centers for Medicare and Medicaid Services and private insurers has remained strikingly low. Despite a general lack of knowledge among surgeons regarding appropriate billing and reimbursement strategies for IONM, some success has been obtained in local markets and requires a separate procedure note documenting the surgeon’s primary active control of the key aspects of IONM.