Neurology & Pain Management Coding Alert

Question: My neurologist completed an extended EEG and sleep staging polysomnography study on the same patient the same date, but our payer denied because the EEG recording is part of a sleep study. Is there a way to get reimbursed for the EEG?

Kansas Subscriber

Answer: If your neurologist is performing the extended diagnostic EEG study in a separate session from the polysomnography, it is compliant coding to append modifier 59 (Distinct procedural service) to the EEG code to allow processing for both diagnostic studies.

EEG procurement for polysomnography (sleep staging) differs greatly from that required for diagnostic EEG testing (for instance speed of paper, number of channels, etc.). Accordingly, do not report EEG testing with polysomnography unless performed separately; report modifier 59 with the EEG tests, if rendered with a separate report, indicating that this represents a different session from the sleep study.

Include a same session EEG with polysomnography. The CPT section guidelines for sleep testing indicate that polysomnography includes a 1-4 lead EEG study. Additional parameters of sleep also include extended EEG monitoring. Medicare's Correct Coding Initiative (CCI) edits bundle the extended EEG monitoring codes (95812, Electroencephalogram (EEG) extended monitoring; 41-60 minutes; and 95813, ... greater than 1 hour) as components of the sleep staging study codes (95808 -- 95811, Polysomnography; sleep staging with ...). Chapter 11 of the Medicare CCI Manual states that polysomnography requires at least one central and usually several other EEG electrodes.