Inpatient Facility Coding & Compliance Alert

Question: Can we bill for an EEG when our physician reads one in addition to a hospital visit? We have faced a denial from Medicare. Can you please provide guidance for the best approach?

Illinois Subscriber 

Answer: You can report EEG reading with hospital visit. The NCCI (National Correct Coding Initiative) currently has no bundling edits between the electroencephalogram codes and the initial or subsequent visit E/M codes. Medicare, however, does cover the diagnostic testing services provided in a facility setting, such as a hospital, POS (Place of service) 21, as separate components. Note that the technical component of diagnostic testing is included in the facility’s DRG payment. Your physician must bill the EEG reading with modifier 26 (Professional component) to be paid for the professional component only. You will typically face a denial with Medicare for a diagnostic testing billed globally, i.e. when you append no modifier for a service performed in a facility. This presumes a diagnostic test that has technical and professional component in RBRVS. Some of the diagnostic tests are broken out with individual CPT® code (e.g., EKGs).