Neurology & Pain Management Coding Alert

Question: I just got a job working in a pain management clinic located within a hospital. One of my first claims involves an electroencephalogram (EEG). On the claim, it says the clinician performed an extended monitoring EEG; total encounter time is 73 minutes. How should I code this encounter?

Virginia Subscriber

Answer: It depends on whose EEG equipment the clinician used for the procedure. Given the locale of your PM clinic, the clinician might have used facility-owned equipment. Then again, your PM clinic might own the EEG equipment in question.

Do this: Ask the clinician if she used facility-owned equipment for the EEG. If she did use facility equipment, report 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour) for the EEG with modifier 26 (Professional component) appended to show that you are only coding for your clinician's services, not the use of the EEG equipment.

If the clinician used equipment that your practice owns, just report 95813 with no modifiers.

Modifier 26 breakdown: CPT® designed modifier 26 for use when clinicians use a facility's resources for a test or service. Often, a CPT^® code's relative value units (RVUs) are broken down into a technical component and a professional component; you'll append modifier 26 when your physician only provides the professional component of one of these

On modifier 26 claims, the facility will often submit the same code with modifier TC (Technical component) appended to show that they are only coding for the equipment use, not the professional component.