Neurology & Pain Management Coding Alert

Question: How should I code a digital ambulatory EEG with 21-32 leads for continuous monitoring and checking for seizures and spike detection? What reimbursement is typical for these procedures?

Colorado Subscriber
 
Answer: Report digital analysis of electroencephalogram, which occurs without the patient being present, using 95957 (digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]). This code is only reported with 95816 (electroencephalogram [EEG] including recording awake and drowsy [including hyperventilation and/or photic stimulation when appropriate]), 95819 (...  including recording awake and asleep [including hyperventilation and/or photic stimulation when appropriate) or 95954 (pharmacological or physical activation requiring physician attendance during EEG recording of activation phase [e.g., thiopental activation test]).
 
Use of 95957 assumes that additional patient difficulties, e.g., epilepsy, justify the procedure. According to CPT Assistant, November 1998, "The EEG, evoked potential and sleep services [such as 95957] ... include tracing, interpretation and report. For interpretation only, use modifier '-26' (professional component) or 09926."
 
The CMS Physician Fee Schedule assigns 95957 4.87 relative value units (RVUs) without modifier -26, and 2.87 RVUs with modifier -26. The payment averages $200, according to HealthCare Consultants' 2001 Physician Fee & Coding Guide.