Neurology & Pain Management Coding Alert

Follow our experts- advice on which is which -- and how you code them

Performing electroencephalography (EEG) might be common for your neurologist, but correct coding still involves some sleuthing on your part. Follow these tips to ensure you correctly report routine or long-term EEGs or related services.

CPT 2007 divides EEG codes into two main categories: 95812-95830 for routine EEG and 95950-95962 for special EEG tests. 

Most of the codes are self-explanatory, but each section includes notes -- and other non-CPT resources -- to help keep your coding on track.

Differences in Rules Guide Routine EEG Coding

One of the biggest questions in EEG coding used to concern the -extended monitoring- codes: When did you shift from routine to extended (or long-term) monitoring? CPT answered that question a few years ago by stating specific timeframes for 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (- greater than one hour).

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.

Other questions still remain, however, about other aspects of coding routine EEGs. Brush up on your routine EEG coding with these insights from Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center in Shadyside:

Question 1: What is the minimum number of channels or electrodes the neurologist must use before reporting 95812 and 95813?

Answer 1: The physician must meet the minimum technical standards for an EEG test. This includes a minimum of 20 minutes of monitoring, plus at least eight channels and other rules as set forth by national organizations such as the American Clinical Neurophysiology Society (www.acns.org). Many physicians use more than eight channels nowadays, thanks to newer technology, says Marianne Wink-Sturgeon, RHIT, CPC, ACS-EM, of the University of Rochester Medical Center's neurology department. Note: This same advice applies to 95822 and 95955 (Electroencephalogram [EEG] during nonintracranial surgery [e.g., carotid surgery]).

Question 2: What is the difference between codes 95816 and 95819?

Answer 2: The patient must have fallen asleep before you can report 95819. If she doesn-t, you should submit 95816 instead. The line between -drowsy- and -asleep,- however, can often be difficult to determine. Some coders say you can report 95819 if your neurologist intended to conduct a sleep study but the patient did not obtain sleep, despite the technician's best efforts.

But Sturgeon-Wink warns against this strategy. -Your physician could intend to perform any procedure, but to bill it on intention would be a big compliance issue,- she says. -We must code and bill what is done, not based on theory.-

Possible exception: If your insurance carrier provides written guidance saying you can bill 95819 in these situations, follow the guideline. You-re billing based on carrier justification rather than a coder's decision. 

Question 3: Our new EEG machine has video monitoring equipment. Is there an extra code to bill for an EEG with video?

Answer 3: These machines allow the technologist to train the video monitoring equipment on the patient during a routine EEG. This recording of what the patient did during the EEG helps the neurologist correlate the patient's actions with the test results. 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).

Watch Your Times With Long-Term Monitoring

CPT's -Special EEG Tests- section includes several codes for long-term monitoring (95950-95956).

You-ll report most of these codes for -each 24 hours.- Questions arise, however, when the monitoring lasts for less than 24 hours but more than the time spent on a routine EEG. Where do you draw the line when the monitoring lasts for eight or 10 hours instead?

Experts weigh in: In the opinions of the American Academy of Neurology and the American Clinical Neurophysiology Society, using more than half of the 24 hours of monitoring is adequate to report these codes. For example, if the recording time is less than 12 hours, you should bill the appropriate monitoring code (such as 95950, Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic [e.g., 8 channel EEG] recording and interpretation, each 24 hours). Then append modifier 52 (Reduced services) to indicate the monitoring lasted less than 24 hours, and note the actual number of hours the study was performed and include other documentation to explain the procedure.

CPT differs: The Principles of CPT Coding, Fourth Edition, provides a different opinion on these situations. It states, -Video-EEG monitoring (95951) is used for prolonged monitoring of seizures. Usually, the coded procedure lasts 24 hours. Sometimes the monitoring is shorter, e.g., because the patient was off monitoring to undergo magnetic resonance imaging. 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.-

Bottom line: Just as carriers sometimes have different opinions on how to code other services correctly, they might differ on how to correctly report long-term monitoring that lasts less than 24 hours. Verify your carriers- policies to ensure you code appropriately.

Don't Assume 95957 Is Correct for Digital

Code 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]) represents digital analysis, but that doesn't mean you-ll always use it for digital services.

-Code 95957 should not be used simply when the EEG was recorded digitally,- Busis says. Why not: There's no additional charge for turning on an automated spike and seizure detector on a routine EEG, ambulatory EEG or video-EEG monitoring. There is also no additional code for performing EEG on a digital machine instead of an older-generation analog machine.

-Some features of digital EEG make it easier and quicker to read, but other features slow it down by providing new optional tricks and tools,- Busis says. -Overall, it is about the same amount of work as using an analog EEG.-

When to use it: Look to 95957 when substantial additional digital analysis was medically necessary and was performed, such as three-dimensional (3D) dipole localization.

-I understand this as using post-acquisition for topographic localization of epileptiform patterns or ictal patterns using dipole source localization or a similar technique,- Wink-Sturgeon says. -Anything else is apparently built into the other CPT codes for  spike/seizure detection.-

Coders in specialty centers such as those with epilepsy surgery programs will most likely report 95957. Wherever you work, Wink-Sturgeon says, your documentation must support any code you submit.

Pay Attention to Potential Bundles

Although some procedures don't mention EEG in the descriptors, you should still watch for correlations.

Example: Code 94772 (Circadian respiratory pattern recording [pediatric pneumogram], 12 to 24 hour continuous recording, infant) doesn't specifically mention EEG. But the accompanying note in CPT reads: -Separate procedure codes for electromyograms, EEG, ECG, and recordings of respiration are excluded when 94772 is reported.-

What it means: CPT's statement confuses many people, which means coders might offer different perspectives. The bottom line is, you should not report EEG codes separate from 94772 because the services are bundled. Before filing your claim, however, check with your carrier to verify their stance.