Neurology & Pain Management Coding Alert

Question: Would you explain the requirements for reporting digital EEG analysis (95957)? Can we report 95957 with any EEG code?


Montana Subscriber

Answer: If your neurologist's documentation leaves any doubt as to whether he performed digital EEG analysis, chances are he hasn-t. You should report 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]) only when the physician or technologist uses quantitative analytical techniques, including data selection, quantitative software processing, and dipole source analysis.

Guideline: Digital EEG analysis generally involves an additional hour or more of work from the neurologist or technician to process the EEG data, followed by an additional 15-45 minutes to interpret the data.

If the documentation illustrates that your physician performed these services, you may report 95957 with most EEG codes, including 95812-95827 and 95950-95956.

Extra step: Even with supportive documentation, you must also prove the medical necessity for the additional work to report 95957. Ask the physician to supply evidence that the results of the digital EEG analysis will directly affect patient management. For example, the analysis may have been necessary to determine the types of seizures afflicting an epileptic patient and the appropriate choice of antiepileptic medications.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J; and Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a reimbursement consulting firm in Denver.