Neurology & Pain Management Coding Alert

Question: I have two questions about coding for EEG video monitoring using code 95951 with modifier 26. We are billing for the following EEG video monitoring scenario: EEG monitoring starts on 10/20 from 10 p.m. to 12 a.m. (total 2 hours), 10/21 from 12 a.m. to 12 a.m. (total 24 hours) and 10/22 12 a.m. to 12 p.m. (total 12 hours). The total combined hours for the three days is 38.

If the monitoring is one hour or less, can we bill 99251-26-52, or is there a time limit? Also, I know that the monitoring is based on each block of 24 hours. If the monitoring starts on one calendar day and ends on the next, can we use the date that the EEG ended as the date of service for both days?

Nebraska Subscriber

Answer: To answer your question about time limits, CPT^® guidelines state that, “Codes 95950-95953 and 95956 are used per 24 hours of recording. For recording of more than 24 hours, do not use modifier 52. For recording 12 hours or less, use modifier 52.”

For the first 24-hour period of monitoring (10/21), report 95951 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation [e.g., for presurgical localization], each 24 hours) with modifier 26 (Professional component only). The modifiers apply because you are coding for only the physician’s professional service but the monitoring lasted less than 24 hours.

For the second 24-hour period (10/22), also report 95951-26. The monitoring code is based on hours rather than days (or dates), so tally the total number of hours for that monitoring session to determine whether modifier 52 (Reduced services) applies. The second recording time was 14 hours, so, based on CPT^® guidelines, you will not append modifier 52 because you passed the 12-hour mark.