Neurology & Pain Management Coding Alert

Discover whether you can report an EEG lasting 40 minutes or more If you-re searching for the appropriate electroencephalogram (EEG) code, you may not always find the answer in your CPT book. The following three scenarios will help you decide whether your EEG coding practices are just fine -- or need a serious overhaul. Read the Following Scenarios Carefully Scenario 1: A patient comes to see a neurologist because of seizures (780.39). The neurologist orders an awake and asleep study because changes commonly associated with epilepsy tend to occur during these periods of transition. This means you-ll report an awake and asleep study, 95819 (Electroencephalogram [EEG]; including recording awake and asleep). Is this correct? Why or why not?
 
Scenario 2: The neurologist meets with a new patient who complains of memory loss (780.93). The neurologist performs a 50-minute EEG to determine the nature and cause of the memory loss. In this case, report 95812 (Electroencephalogram extended monitoring; 41-60 minutes) for the EEG, and 99204, with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) appended, for the initial office visit. 
 
Attach a diagnosis of 780.93 to both codes. Is this correct? Why or why not?
 
Scenario 3: A patient has extended convulsive seizures (or status epilepticus, 345.3) -quot; confirmed during previous testing -- that require surgery to correct. To find the exact location in the brain where the seizures originate, the neurologist orders long-term study 95951 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic [EEG] and video recording and interpretation [e.g., for presurgical localization], each 24 hours). Is this correct? Why or why not?
 
Thought about your answers? Now see how you fare in comparison to our experts- responses below. Find Out How Patient's State Affects Coding Answer 1: Not necessarily. When trying to choose between 95816 (Electroencephalogram [EEG]; including recording awake and drowsy) and 95819, you should allow the circumstances that prevail during testing to determine the code you report.
 
If the neurologist tried for an awake/asleep EEG (95819) and the patient did not sleep but the recording time was appropriate, you would still most likely code for the awake/asleep EEG (95819). If the neurologist orders an awake EEG (95816) only, but the patient falls asleep, you should upcode the procedure to 95819 -quot; but be prepared with documentation.
 
Keep in mind: If the neurologist provided a separate E/M service (for example, 99204, Office or other outpatient visit for the evaluation and management of a new patient ...) on the same day, you may also report the appropriate E/M code with modifier 25 appended.
  
Watch out: You should report the -sleep only- code (95822) for patients [...]