Neurology & Pain Management Coding Alert
Remember Modifier 26 for Hospital EEG Reading
Question: I just received a denial from Medicare stating that the EEG reading is inclusive and will not be paid in addition to the hospital visit. Is this correct?
Illinois Subscriber
Answer: No, this is not correct. Currently, there are no NCCI bundling edits between the electroencephalogram codes and the initial or subsequent visit E/M codes. However, diagnostic testing services provided in a facility setting, such as a hospital, POS (Place of service) 21, are only covered by Medicare as separate components. The technical component of diagnostic testing is included in the facility’s DRG payment, while the physician must bill with modifier 26 (Professional component) to be paid for the professional component only. Medicare typically will deny diagnostic testing billed globally, i.e. with no modifier, when performed in a facility.
Neurology & Pain Management Coding Alert
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