Neurology & Pain Management Coding Alert

Precise timing of EEG monitoring is the key, frequency is not important.

When reporting EEG recording, the most crucial factor is to time the procedure. If your physician uses advanced techniques, video and digital recordings, you may be faced with additional coding challenges for these services. Read on to equip yourself on how to precisely time the procedure and code the routine, extended, and special monitoring.

Look For How Long the Diagnostic Study Lasted

When reporting EEG, you should look for how long your neurologist did the monitoring. Monitoring that lasts 20 to 40 minutes is said to be routine. You will report codes for extended monitoring if the procedure exceeds 40 minutes in duration. For EEG recording that lasts 41 to 60 minutes, you report 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes), and if it lasts more than an hour, you report 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour).

"It is important that your neurologist's report clearly documents the actual EEG recording time. Coding is based on the recording while it is underway and the neurologist or technician is collecting data. You do not include the set-up and take-down time" says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver.

Exception: CPT^® excludes EEG codes 95824 (Electroencephalogram [EEG]; cerebral death evaluation only), 95827 (Electroencephalogram [EEG]; all night recording), and 95829 (Electrocorticogram at surgery [separate procedure]) from a time component as these are unique services rendered by the physician to monitor a certain pathological condition or diagnose one.

Important note: You can report 95812 or 95813 in place of 95816 (Electroencephalogram [EEG]; including recording awake and drowsy), 95819 (... including recording awake and asleep) or 95822 (... recording in coma or sleep only), but you cannot report them together. There is a narrow line between drowsy and asleep. You report 95819 when the patient actually slept during the monitoring. If the patient did not attain sleep in a procedure that intended monitoring in sleep, you report 95816 instead.

If the neurology specialist performs the global diagnostic service, i.e. owns the equipment, employs the technical staff and also interprets the diagnostic findings, then the EEG code would be billed without any modifiers. However, you would append modifier 26 (Professional component) to the EEG CPT^® code, if your neurologist only performs the professional interpretation of the diagnostic study. In the latter scenario, the hospital or center owns the equipment and employs the technical staff used to complete the EEG diagnostic study.

Scan For Video and Channels in Extended Monitoring

For 24-hour EEG monitoring, you should assess codes 95950 (Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic [e.g., 8 channel EEG] recording and interpretation, each 24 hours)-95953 (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours, unattended) or 95956 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic [EEG] recording and interpretation, each 24 hours, attended by a technologist or nurse).

Your neurologist may like to obtain a day and night monitoring for say localization of seizures. Be sure to look for the number of channels and also if your neurologist used a video. If he does video EEG monitoring, you would report 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).

If, however, 16 or more telemetry channels were used, but the neurologist does the EEG without video, you report 95956. CPT^® describes these long term monitoring codes for 'special EEG tests' that last 24 hours. If the patient was sent home with an EEG holter monitoring, you report 95953.

Tip: If your neurologist completes the EEG testing in less than 12 hours, you append modifier 52 (Reduced services) to 95951-95953 or 95956. Thus, the 24 hour codes are applicable if the time period for the testing is more than 12 hours up to 24 hours.

The American Academy of Neurology and the American Clinical Neurophysiology Society agree with the 2011 CPT^® Instructions -- "A unit of time is attained when the mid-point is passed" and adopt the monitoring timeline of more than half of the 24 hours of monitoring as adequate to report these codes. Make sure to record the actual number of hours for the monitoring and adequately document the same.

Caution: Carriers may differ in reporting of long-term monitoring that lasts less than 24 hours. Confirm with your carriers for policies and preferences to ensure you report appropriate codes. Some may select monitoring time frame of more than 15 hours as appropriate to report these codes. "In the AMA book 'Principles of CPT^® Coding,' 5^th edition, the time frame is 12 hours, not 15 hours," says Hammer. "For recording 12 hours or less, you use modifier 52."

Important note: You count the 24-hour time frame from when the EEG monitoring begins. Example, if you read that the neurologist performed the EEG monitoring overnight, you look for the exact timing when the procedure began. If the test begins at 9 p.m., then you count 24 hours if it lasted till 9 p.m. on the next day. If your neurologist began the monitoring at 9 a.m. on Monday, and it lasted till 10 p.m. on Tuesday, you report 95951 for Monday and 95951 without a modifier for Tuesday; since the monitoring time was 13 hours.

Editor's note: Read more about reporting EEG in the next issue of Neurology Coding Alert.