Neurology & Pain Management Coding Alert

Question: Which is the correct code for digitally analyzed EEG monitoring? Should I report both 95953 and 95957, or just 95957?

Idaho Subscriber

Answer: You should report a 24-hour electroencephalo-graphic (EEG) study using 95953 (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours). The EEG must use 16 or more channels. In addition, this code does not include video monitoring. If the physician also employs video monitoring, report 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) rather than 95953.

Most neurologists run EEGs on digital machines, but using a digital recorder alone does not qualify the test for submission of 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]). And EEG as described by 95951/95953 typically includes both digital spike and seizure identification. Code 95957 is not appropriate for simple reading of a digital EEG record or for routine automated spike and seizure identification during 95951/95953.

Rather, 95957 is appropriate when the technologist and physician provide additional work for analysis of some features of the EEG (typically, three-dimensional spike localization). If performed, you may report 95957 in addition to 95951 if the physician recorded the spikes during the latter procedure. Many payers stipulate that you must provide medical justification for digital analysis by demonstrating that it affects patient management directly.