Reader Question:
128 Channel EEG May Mean Extensive Work
Published on Sun Nov 25, 2012
Question:
If the provider billed for the interpretation of a 128 channel EEG that took place over 7 days - would you bill 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)-26 (Professional component)? Since the provider is spending more time reviewing 128 channels, is there a way to modify it to reflect extra time it takes to go over all the seizure activity over the course of 7 days the patient was monitored?
Could we report 95951-22 (Increased procedural service), 26 with a letter from the provider documenting the work required to provide that interpretation was substantially greater than typically required for a 16 channel EEG? Or would we use an unlisted code and send the necessary documentation?
New Jersey Subscriber
Answer:
You report the EEG diagnostic testing with use of 16 or more channels based on whether the recording was unattended -- 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), attended -- 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), or video recorded " 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).
Note that all of these three codes are based on each 24 hours. Providers would report 1 unit of service for each 24 hours of testing, i.e. for 72 hours of testing of 16-channel EEG attended by a technologist would be reported with 95956 with three units of service. Modifier 26 would be appended to the appropriate CPT
® code if the provider is only reporting the professional interpretation.
So, depending upon what type of prolonged EEG monitoring was performed, i.e. unattended 95953, attended 95956 or included video recording 95951, the neurologist would report the corresponding CPT
® code with 7 units of service for the 7 days of testing.
In order to report any increased services based on the 128-channel testing versus the 16 or more, the neurologist's documentation would need to support that the professional interpretation was substantially greater than typically required, i.e. increased intensity, time, technical difficulty in performing the interpretation, severity of patient's condition, physical and/or mental effort required, in order to consider appending modifier 22 to the CPT
® code.
