Neurology & Pain Management Coding Alert

Question: Our neurologist is monitoring for localization of cerebral seizures (95951) but he doesn't do it for the full 24 hours. How do we code for this? Is there a modifier to indicate that lesser services were performed?

 

Oklahoma Subscriber

 

Answer: Depending on how long the neurologist monitors the patient, you may still be able to bill 95951. Most carriers allow full payment for this code when the service has been performed for 15 to 30 hours. Your carrier may have different requirements, but this is the basic guideline that most payers follow. If you perform the service for nine to 15 hours, you should code 95951 with modifier -52 to indicate that reduced services were performed. Anything less than nine hours would warrant another code.  For example, a good choice might be 95813 (EEG extended monitoring; greater than one hour) which is probably the closest substitution when you cannot use 95951.

 

If your carrier tells you that they allow usage of 95951 for any time limits other than those listed above, be sure to get their policy in writing (particularly if they say they allow billing this code for services under nine hours).

 

-- Answers for "You Be the Coder" and Reader Questions were provided by Neil A. Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside; and Laureen Jandroep, OTR, CPC, CCS-P CPC-H, owner of A+ Medical Management and Education, a coding and reimbursement consulting firm and a national CPC training curriculum site in Egg Harbor City, N.J.