Neurology & Pain Management Coding Alert

Question: Will the use of an eight-channel rather than a 16-channel ambulatory EEG create a reimbursement difference? Also, are reimbursement rates for eight-channel ambulatory EEGs going to be reduced?

Anonymous Louisiana Subscriber

Answer: Reimbursement for EEGs is based on the number of channels used. Codes should use 95950 (monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic [e.g., eight-channel EEG] recording and interpretation, each 24 hours) for eight-channel ambulatory EEGs. For 16 or more channels use 95953 (monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephablographic [EEG] recording and interpretation, each 24 hours).

EEG machines with a greater number of channels provide more detailed information. Most neurologists recommend the use of at least a 16-channel EEG. Many of the latest digital EEG machines record up to 32 channels; however, there currently is no reimbursement rate differential between the use of 16- and 32- channel units.

There are no planned reimbursement rate reductions for eight-channel EEGs. There was discussion, however, that the reimbursement rates would be reduced for certain EEGs prior to the November 1999 release of the new Medicare rates. According to the American Academy of Neurology (AAN), inpatient and hospital outpatient reading fees for EEGs did drop slightly. The rates for awake and asleep EEG did not improve, but the rates for awake only EEG and extended EEG increased 25 to 30 percent.

Neurologists should review their coding for those procedures carefully, as otherwise minor coding decisions (such as billing for awake and asleep EEG when an awake only EEG is performed) can result in substantially different payments under this particular fee schedule.

Note: Medicare rates, including increases and decreases in fee schedules, may vary slightly from state to state. Coders should obtain their states current policy for the most accurate information possible.