Neurology & Pain Management Coding Alert

Question: The neurologist monitored a patient for localization of cerebral seizures, but not for a full 24 hours. How should we report this?

Massachusetts Subscriber

Answer: The appropriate code to report monitoring for cerebral seizure localization is 95951 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalo-graphic [EEG] and video recording and interpretation [e.g., for presurgical localization], each 24 hours). Although the descriptor specifies "each 24 hours," payers may allow full payment for 95951 when monitoring has lasted a minimum of 15 hours and up to a maximum of 30 hours.

When performing monitoring for nine to 15 hours, report 95951 with modifier -52 (Reduced services) to indicate a reduced service. For fewer than nine hours, a good code choice is 95813 (EEG extended monitoring; greater than one hour).

Be aware that payers vary on this issue: If your carrier tells you that it allows use of 95951 for any time limits other than those listed above, be sure to get its policy in writing (particularly if the payer says it allows billing 95951 for services less than nine hours). Note also that many Medicare carriers require that extended monitoring as described by 95950-95953 and 95956 be preceded by a resting EEG such as 95819-95822 or 95827. Ask your payer for its individual policy.