Neurology & Pain Management Coding Alert

Question: The neurologist reprogrammed a patient’s VNS. Later that day he did an EEG to see if the patient had epileptic seizures. I thought if the patient had a Vagal Nerve Stimulator (VNS) it is because they have epilepsy or epileptic seizures. Is it is correct to do an EEG on someone who has a VNS? Can codes 95974 and 95816 be billed together?

North Carolina Subscriber

Answer: The Correct Coding Initiative (CCI) does not list any edits preventing you from reporting 95974 (Electronic analysis of implanted neurostimulator pulse generator system [e.g., rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements]; complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour) and 95816 (Electroencephalogram [EEG]; including recording awake and drowsy) together.

Double check: Verify that your provider is also documenting the time for the VNS reprogramming, as the code is time-based (up to one hour). Some payers have very specific diagnosis codes they allow with 95974. Under ICD-9 you sometimes were able to only report 345.41 (Localization-related [focal] [partial] epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy) or 345.51 (Localization-related [focal] [partial] epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy). ICD-10 expands to several possibilities that cross from these former diagnoses, including:

• G40.211 – Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus
• G40.219 – … without status epilepticus
• G40.111 – Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus
• G40.119 – … without status epilepticus
• G40.011 – Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus
• G40.019 – … without status epilepticus.

You need to know the type of seizures the patient experiences (simple, complex, or of localized onset) and whether status epilepticus is present. As always, the better your provider’s notes are, the easier it will be for you to choose the appropriate diagnosis.