Neurology & Pain Management Coding Alert

One of the main sources of confusion in EEG coding surrounds "extended monitoring" codes. You need to understand when your testing makes the transition from routine to extended -- or long-term -- monitoring.

CPT addressed this long-standing coding question several years ago by including specific durations in the descriptors for 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (- greater than one hour).

If your test meets the time requirements, you can report using 95812 or 95813 in the place of the following codes:

- 95816 -- Electroencephalogram (EEG); including

- 95819 -- - including recording awake and asleep

- 95822 -- - recording in coma or sleep only.

Important: You need to keep in mind that you can never report 95812 together with these codes.

Some examples: Your neurologist tests a patient for 30 minutes. The subject falls asleep 20 minutes into the procedure. Because the patient was awake for part of the test, you should code using 95819.

But if the physician administered the same tests under the same conditions for 45 minutes, you would opt for code 95812 because the procedure lasted over 41 minutes.

Be advised: Many carrier guidelines state that the service 95812 describes cannot be the patient's first EEG because you must establish medical necessity before performing an extended EEG. Check your documentation and your carrier's coverage policy to make sure you have all your bases covered.