Intraoperative Nerve Monitoring Crisis: Sounding the Alarm

Objectives: Otolaryngology was one of the first specialties to use intraoperative nerve monitoring (IOM) to reduce the risk of facial and recurrent laryngeal nerve paralysis. Unfortunately, many external changes have occurred in the field that impact standards of care and correct coding. The objective is to identify these new external standards so AAO members can describe and apply new regulations to reduce adverse medicolegal and coding abuse risks. Methods: Rigorous, newly published standards in neurophysiologic monitoring created by neurologic and electrodiagnostic associations are reviewed and compared with the more lax procedures commonly used by otolaryngologists with informal, on-the-job IOM training. Similarly, new third party payor changes in billing and coding are reviewed and compared to common IOM coding practices. Results: A comparison of routine IOM methods performed by otolaryngologists reveals marked differences in procedure and documentation compared to published standards in neurophysiological monitoring. In addition, many otolaryngologists have failed to change their IOM coding strategies to comply with new third party payor guidelines. Conclusions: (1) The absence of specialty-specific American Academy of Otolaryngology Practice Guidelines on IOM places otolaryngologists at risk for noncompliance with external standards published in the neurophysiology field. Failure to observe national standards of IOM also compromises the quality of the monitoring provided to our patients. (2) Because “ignorance of the law is no excuse,” failure to identify and comply with new IOM coding regulations places the otolaryngologist at risk for charges of “fraud and abuse” billing. Implementing both clinical and coding changes will benefit patient and physician alike.