Neurology & Pain Management Coding Alert

Question: My neurologist did the professional component of 95819 with equipment we own, here in the practice. Which modifier do I use ?

Texas Subscriber

Answer: There is no modifier required in this scenario. Since your neurologist performed both the technical (modifier TC) and professional (modifier 26) components in an office setting (POS 11), submit a CMS-1500 form with 95819 (Electroencephalogram [EEG]; including recording awake and asleep) and no modifier to indicate he provided the global diagnostic study. A complete procedure such as this -- that is, a procedure with both a professional and technical component -- billed with no modifier attached to the procedure code is eligible for reimbursement when the provider owns the equipment, employs any required technical staff, and also provides the professional component.