Neurology & Pain Management Coding Alert

Question: When billing for an office ambulatory EEG (95950), can we also bill 95957 for the physician reading of the EEG?


Colorado Subscriber

Answer: With proper documentation, you may report 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]) with most electro-encephalogram (EEG) codes, including 95812-95827 and 95950-95956.

However, most neurologists run EEGs on digital machines - but using a digital recorder alone does not qualify the test for submission of 95957. True "digital" analysis, as described by 95957, requires that the neurologist or technologist conduct the analysis using quantitative analytical techniques such as data selection, quantitative software processing, and dipole source analysis.

You must provide medical necessity to report 95957, and the physician must supply evidence to demonstrate that the results will affect patient management directly. For example, EEG results are critical in the surgical treatment of epilepsy. A patient's seizures may be pronounced and easily recognized, or they may occur in a matter of seconds and be difficult to detect. The neurologist may place such a patient on an EEG machine for an extended period during a seizure cycle, which may last for hours or even days.

In such cases, digital analysis of the EEG enhances the clinician's ability to identify abnormal spikes, rhythmic discharges, epileptiform activity and localization of discharges.