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 who are comatose, anesthetized or neonates.
 
Don't forget: If the neurologist performs the test in the hospital setting using hospital equipment, you-ll need to add modifier 26 (Professional component), says Catalina Fisher, CPC, coder at Neurologic Associates of Waukesha LTD in Wisconsin.

Evaluate Reporting Extended EEG

Answer 2: Yes. As a rule, you can claim an extended EEG for monitoring lasting 40 minutes or longer. A -typical- EEG (for example, 95816, 95819 or 95822) lasts about 20-40 minutes, according to CPT guidelines. For monitoring of 41 minutes to one hour, report 95812 (Electroencephalogram extended monitoring; 41-60 minutes). For monitoring of an hour or more, report 95813 (... greater than one hour).
 
Do not report an extended EEG and a routine EEG at the same time. The extended EEG codes are not add-ons but are designed to replace 95816, 95819 or 95822 for monitoring lasting 40 minutes or more.
 
As for the E/M service, your neurologist may be prompted to evaluate the symptom or condition that initiated the EEG in the first place. In that case, you won't need different diagnoses for the EEG and the E/M visit, but your documentation must support both services, Fisher says.
 
Keep in mind: You may need to append modifier 25 to the E/M visit, says Lydia Robles, CPC, coder at Neurologic Associates of Waukesha LTD in Wisconsin.

Learn What a Long-Term EEG Entails

Answer 3: Yes, says Patti Mazzacavallo, CPC, coder at Neurologic Associates of Waukesha LTD in Wisconsin. To report long-term monitoring (95950-95951, 95953, 95956), the neurologist first must have conducted conventional EEG studies (such as 95816, 95819, 95822 or 95827) to determine medical necessity for the more extensive tests, according to Medicare and most third-party payer guidelines.
 
A typical Medicare coverage policy states simply, -Reimbursement [for long-term EEG monitoring] is limited to patients in whom a seizure disorder is suspected, but unconfirmed by conventional EEG studies.-
 
Remember: Guidelines vary from state-to-state, so you always have to deal with the fact that this may not be a service covered by the contract between patient and employer, Mazzacavallo says.
 
Long-term EEGs are -seizure-focus- in nature, meaning the neurologist orders the tests to track and analyze brain seizures, such as those common in epilepsy patients. Specifically, these tests allow neurologists to pinpoint the reasons for seizures and to help them localize the portion of the brain affected.