Neurology & Pain Management Coding Alert

Question: Medicare denied an EEG interpretation billed on the same day as an initial hospital admission and spinal tap. Is the interpretation included in the history and physical?

Michigan Subscriber

Answer: The interpretation isn't part of your neurologist's initial hospital care service, but it is a Column 2 code of the spinal tap. Append modifier 59 (Distinct procedural service) to indicate the EEG and spinal tap are separate services. Your claim should read as follows:

• 62270 (Spinal puncture, lumbar, diagnostic)
• 95819 (Electroencephalogram [EEG]; including recording awake and asleep) with modifier 26 (Professional component) and modifier 59
• The appropriate choice from 99221-99223 (Inpatient hospital care, per day, for the evaluation and management of a patient ...).