Neurology & Pain Management Coding Alert

Reader Question:

Computerized EEG Analyses

Question: Our neurologist spends a lot of time on computerized analyses of EEGs, but we can't get reimbursed for them. Is there a specific code for this type of analysis?
Maine Subscriber   Answer: You should use 95957 (digital analysis of EEG). Some carriers reimburse for it, but that varies on a state-by-state basis. A few private carriers consider it experimental in nature, while other insurers (including some Medicare carriers, such as Pennsylvania) have attached fees of about $200 to the code, which is a sizable amount. This code does include a technical (-TC) and professional (-26) component, so if the neurologist is simply interpreting a test that was performed at another location, he or she should bill 95957-26 rather than billing the entire fee. If the neurologist owns the testing equipment and employs the staff that operates it, he or she can bill for the full fee.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more