Neurology & Pain Management Coding Alert

Question: May we report ambulatory EEG (95953) with digital analysis (95957) for continuous monitoring and checking for seizures and spike detection?

Oklahoma Subscriber Answer: No, you should not report 95953 and 95957 at the same time.
 
Digital screening for spikes and seizure detection is included in 95953 (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours). As such, you should not report the service a second time using 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]).
 
You may apply digital analysis 95957 only with 95816 (Electroencephalogram [EEG]; including recording awake and drowsy), 95819 (... including recording awake and asleep) or 95954 (Pharmacological or physical activation requiring physician attendance during EEG recording of activation phase [e.g., thiopental activation test]), according to CPT guidelines.
 
Use caution when reporting 95957. All EEGs use digital recording methods - and you should not claim digital analysis just because the EEG was recorded digitally.
 
Digital recording uses a digital EEG recorder but is digital only to the extent that an analog paper recorder is not used at the time of wave-form capture. This represents a typical EEG interpretation in most clinical situations, and you should report this using 95816, 95819 or 95822 (Electroencephalogram [EEG]; recording in coma or sleep only), as appropriate. The digital analysis may also be used in addition to a visual reading of the record.
 
True digital analysis requires the use of quantitative analytical techniques such as data selection, quantitative software processing, and dipole source analysis. This type of processing generally entails an extra hour of work by the technician to process the data from the digital EEG, as well as an extra 20-30 minutes of physician time to review the technician's work and the data produced.
 
You must provide medical necessity to report 95957, and the physician must supply evidence to demonstrate that the results will affect patient management directly.
 
Digital EEG analysis is warranted in selected instances only (for example, in epileptology, for spike detection or dipole analysis) and is rarely necessary for routine patient management. As such, contact the payer prior to billing to determine what ICD-9 codes and documentation will justify the procedure.