Neurology & Pain Management Coding Alert

Question: Our practice recently performed an electroencephalogram (EEG) on a patient who presented with amnesia. We used ICD-9 code 780.9 (other general symptoms including amnesia), and the claim was rejected by Medicare as not medically necessary. How can we get this claim paid?

Missouri Subscriber

Answer: The most important question to answer in this instance is why the EEG was performed, says Erwin Montgomery, MD, director of the movement disorders program for the Cleveland Clinic in Cleveland, which has more than 40 neurologists on staff. An EEG may be performed as one test to attempt to determine the nature and cause of the memory loss. Specifically, memory loss may stem from psychogenic or organic causes.

If profuse changes are seen in the EEG, the neurologist may view this as an indicator that the cause of the memory loss is organic. If the EEG results are normal, the problem may be psychogenic. EEG testing is not a definitive means of determining the cause of memory loss, however, it often is used as a screening tool to learn if the patient suffers from any underlying neurological damage.

The neurologist should contact his or her local Medicare carrier and ask what diagnosis code will be accepted to justify the medical necessity of performing this test. Montgomery says that other diagnosis codes that also describe this service may well be covered, such as organic brain syndrome (310.9). Unspecified diagnosis codes may be used, but Montgomery warns that they have a high probability of being denied.