Neurology & Pain Management Coding Alert

Question: May we charge ambulatory EEG (95953) and digital analysis (95957) with 21-32 leads for continuous monitoring and checking for seizures and spike detection? What is the proper use of 95957?
      
Texas Subscriber

 
Answer: Digital screening for spikes and seizure detection is included in 95953 (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours). As such, it is incorrect to bill this a second time using 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]).
 
Digital analysis 95957 is a stand-alone code that may be reported by the same or a different physician from the one who performed the EEG. Code 95957 is applicable only with 95816 (Electroencephalogram [EEG] including recording awake and drowsy [including hyperventilation and/or photic stimulation when appropriate]), 95819 ( awake and asleep ) or 95954 (Pharmacological or physical activation requiring physician attendance during EEG recording of activation phase [e.g., thiopental activation test]).
 
Use caution when reporting 95957. All EEGs use digital recording methods but digital analysis should not be used only when the EEG was recorded digitally. Digital recording uses a digital EEG recorder but is digital only to the extent that an analog paper recorder is not used at the time of wave-form capture. This represents a typical EEG interpretation in most clinical situations and should be reported using 95816, 95819 or 95822 (Electroencephalogram [EEG]; sleep only), as appropriate. The digital analysis may also be used in addition to a visual reading of the record. 
 
True digital analysis requires the use of quantitative analytical techniques such as data selection, quantitative software processing and dipole source analysis. This type of processing generally entails an extra hours of work by the technician to process the data from the digital EEG, as well as an extra 20-30 minutes of physician time to review the technicians work and the data produced.
 
Medical necessity must be proven to report 95957, and there must be strong evidence to demonstrate that the results will affect patient management directly. Digital EEG analysis is warranted in selected instances only (e.g., in epileptology, for spike detection or dipole analysis) and is rarely necessary for routine patient management. As such, contact the payer prior to billing to determine what ICD-9 codes and documentation will justify the procedure.
 
For example, an epilepsy center may perform EEG dipole analysis on the EEG for presurgical planning. The technologist spends an additional 45 minutes marking out spikes for analysis, averaging, running calculations and plotting 3-D localizations. The physician spends an additional half-hour checking the markings, interpreting the 3-D location, and marking a report. Report the service using the basic EEG recording code (e.g., 95819) in addition to the added dipole analysis work (95957).