Neurology & Pain Management Coding Alert
Check CCI, Then Look at Dx Codes Post-Denial
Question: I recently reported a combined electroencephalographic [EEG] and video recording, along with digital analysis for epileptic spikes, with codes 95951 and 95957. Our payer is denying 95957, however, saying only 95951 is payable. Has the Correct Coding Initiative (CCI) started bundling these codes? California Subscriber Answer: No, as of CCI version 23.1, which is valid through June 30, these two codes are not bundled. According to CPT® guidelines, “Codes 95950-95953 and 95956 are used per 24 hours of recording,” so you should report 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) once if you perform the service for one day. You would report 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]) for the 24-hour period, regardless of the number of spikes analyzed. It is not appropriate to report code 95957 for source localization when there are no spikes to analyze (when the video-EEG monitoring is normal). Therefore, it’s possible that your documentation or diagnosis suggested that 95957 was not medically necessary for the service. Best bet: Contact the payer and inquire about the reason for the denial.
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