Neurology & Pain Management Coding Alert

Question: Does my provider need to document certain things to prove medical necessity before billing an extended EEG (95812)? Should the code be billed in addition to 95819?

Louisiana Subscriber

Answer: Medical necessity does come into play when billing for an extended EEG because the provider is completing a much longer EEG than normal. Be sure you have sufficient documentation before billing 95819 (Electroencephalogram [EEG]; including recording awake and asleep) with 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes). You’ll also need to append modifier 59 (Distinct procedural service) to 95819 when reporting both services together.

Be aware: It typically wouldn’t be appropriate to report both codes. You would only need both if the patient had two separate EEG diagnostic studies performed on the same day – one awake and asleep and the other with extended monitoring time. Remember, 95812 is not an “add-on” code that is used to report additional extended monitoring, (such as “each additional x minute”s) but rather represents the total amount of time for the EEG.

According to the American Academy of Neurology (AAN), “Codes 95812 and 95813 can be used in place of 95816, 95819 or 95822 but are not to be billed together with them.”