Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that the a patient underwent an electroencephalogram (EEG) that lasted three hours and seven minutes. I reported 95812 and 95813 and received a denial. Why?

Kansas Subscriber

Answer: While reporting 95812 (Electroencephalogram (EEG) extended monitoring; 41-60 minutes) and 95813 (… 61-119 minutes) might make sense mathematically, CPT^® issued explicit instructions on what to do when EEGs last more than two hours.

In the notes below 95813, CPT^® instructs: “For long-term EEG services [2 hours or more], see 95700-95726”

Good news: When you report an EEG of more than two hours, you can submit a for setup: 95700 (Electroencephalogram (EEG) continuous recording, with video when performed, setup, patient education, and takedown when performed, administered in person by EEG technologist, minimum of 8 channels)

Warning: As the descriptor for 95700 reads, the provider needs to use a minimum of eight channels in order to report this code for setup. If the EEG uses fewer than eight channels, then report 95999 (Unlisted neurological or neuromuscular diagnostic procedure) for the setup. Also, if the provider is not an EEG technologist, then you should report 95999 instead of 95700.

Then, you’d choose one of the following codes for the three-hour EEG, depending on encounter specifics:

• 95705 (Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist, 2-12 hours; unmonitored)
• 95706 (… with intermittent monitoring and maintenance)
• 95707 (… with continuous, real-time monitoring and maintenance).