Neurology & Pain Management Coding Alert

The key insights into electroencephalography (EEG) coding and its effect on reimbursement are easier to understand than you think. Our experts help guide you through the process.

For coding success, the first thing you need is a concise yet informative report to base your coding decisions on. You also need to be informed about the elements that make up the EEG codes.-

"For example, some of the things you need to consider are whether the patient was asleep, awake or both during the procedure," says Lynn McCormack, CPC, with HCA Physician Services in Las Vegas. "How long was the study performed for? Was there video recorded during the procedure? All of this information should be in your report. Once you have the answers to these questions, you are on your way to finding the appropriate code." Here's what you need to know.

Neurologists must meet certain minimum technical standards for administering an EEG test. These include the following:

- at least 20 minutes of monitoring

- a minimum of eight channels.

Experts note that, due to technological advances, many physicians now use more than eight channels during testing.

Tip: National organizations, such as the American Clinical Neurophysiology Society (www.acns.org), have established additional rules, so be sure your practice knows which standards it needs to meet.

Reminder: These criteria apply to 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (- greater than one hour), as well as 95822 (Electroencephalogram [EEG]; recording in coma or sleep only) and 95955 (Electroencephalogram [EEG] during nonintracranial surgery [e.g., carotid surgery]).

When you-re coding for a patient who was not fully conscious throughout a test, using 95816 (Electroencephalogram [EEG]; including recording awake and drowsy) and 95819 (- including recording awake and asleep) can raise a lot of questions. There can be a fine line between "drowsy" and "asleep."

What to do: You can only report 95819 if documentation shows that the patient fell asleep. If the patient didn't fall asleep, you should submit 95816.

For example: Your neurologist administers an EEG that lasts for 25 minutes. You check the documentation and find that during the testing, the patient came close to losing consciousness, but that she never actually fell asleep. In this situation, your correct coding choice would be 95816.

Side note: Some coders have suggested that reporting 95819 is legitimate if your neurologist intended to conduct a sleep study but the patient did not actually fall asleep, despite the technician's best efforts. Experts note, however, that billing based on a physician's "intention" can create significant compliance issues.

Bottom line: Only code and bill the procedures the providers documented and performed.

CPT also contains a "Special EEG Tests" section that includes several codes for long-term monitoring. You-ll report most of these codes (95950-95956) for "each 24 hours."

Problem: You must determine how to code for monitoring that lasts less than 24 hours but longer than the times specified for other routine EEG testing.

The official position: Both the AAN and the ACNS state that coding for any testing that lasts for more than half of the prescribed 24-hour monitoring period is sufficient to justify reporting using these codes.

Not so fast: You need to be aware that the AMA isn't in complete agreement with these positions, however.

The AMA's Principles of CPT Coding, Fourth Edition, states that video monitoring of EEG testing is used "for prolonged monitoring of seizures."

The AMA indicates that the 95951-coded procedure usually lasts 24 hours but that the monitoring period may be shorter -- for example, if the patient was taken off monitoring in order that magnetic resonance imaging could be performed.

The AMA continues, "When monitoring is less than 15 hours, but more than 8 hours, use modifier 52. When monitoring is less than 8 hours, use code 95813 instead of code 95951."

The verdict: Check with your carrier to determine its policy so you can be certain you-re correctly coding for long-term monitoring lasting less than 24 hours.

Technology often advances faster than CPT can keep up.

Potential problem: Some EEG machines are now equipped with video monitoring equipment. This allows technologists to record a patient's activities during a routine EEG procedure, which in turn helps the neurologist accurately correlate the patient's actions with the test results.

This new equipment has led coders to ask whether there is a special code they should use for procedures using video monitoring.

The answer: CPT includes a code for 24-hour video recording and interpretation, so you report it instead of searching for additional codes: 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).

You might assume that the logical coding option for digital analysis would be 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]). However, you won't always use this code for digital services.

When not to use the code: You shouldn't necessarily use 95957 just because the EEG was recorded digitally, says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the UPMC Shadyside, Pittsburgh.

"Code 95957 is not used in addition to your regular 20-minute EEG and should not be used because an EEG was recorded digitally versus on an older machine that might record in analog," McCormack adds.

Remember: There isn't an additional coding choice for testing performed with a digital machine as opposed to EEGs using an analog machine. And there isn't an additional charge for turning on an automated spike and seizure detector on a routine EEG, ambulatory EEG or video-EEG monitoring.

When it's all right to use the code: McCormack advises using 95957 "to report substantial additional digital analysis. This additional analysis should be medically necessary and indicated as such."

She further notes that, according to the AAN, 95957 "would entail an extra hour's work by the technician to process the data from the digital EEG and an extra 20 to 30 minutes of physician time to review the technician's work and review the data produced."-

For example: You-re coding for a patient who underwent substantial additional digital analysis. The neurologist established medical necessity, and the patient received three-dimensional dipole localization. Your correct coding choice for this procedure is 95957.

Use 95957 with other EEG codes to indicate the more extensive digital service provided. Coders in specialty centers -- those with epilepsy surgery programs, for example -- are the most likely to report this code.