Neurology & Pain Management Coding Alert

Question: How should I report a video EEG for less than 24 hours? Do I need to append modifier -52?

Georgia Subscriber

Answer: The appropriate code for video electro-encephalography (EEG) of 15-24 hours is 95951 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic [EEG] and video recording and interpretation [e.g., for presurgical localization], each 24 hours), according to coding conventions supported by the American Clinical Neurophysiology Society and many insurers. You do not need to append modifier -52 (Reduced services) for fewer than 15 hours of monitoring, although you should append the modifier for 15 hours or less. Not all payers follow this policy, however, so you may wish to contact the individual insurer prior to billing.
 
If the video EEG extends beyond 24 hours, you may report multiple units of 95951. And remember to append modifier -26 (Professional component) to clarify that the neurologist is providing only the interpretation and report, and does not incur the cost of running/maintaining the necessary equipment.