Neurology & Pain Management Coding Alert

Question: Our neurologist wants to start ordering precautionary EEGs for a patient who has controlled seizures but drives. He's thinking in terms of one EEG a year unless otherwise indicated. What standards exist for precautionary EEGs?

Answer: Physicians should order EEGs whenever they deem medically necessary for the patient. Most payers don't have a frequency standard for EEGs, but it is always best to check to verify that the diagnostic tests are a covered benefit and any other payer restrictions.

Heads up: Although the laws vary from state to state, most states have rules regarding when seizure patients can legally resume driving. Typically, patients must be seizure free 6 months to a year. South Carolina law, for example, states that you cannot drive for six months. If the person has another seizure or loss of consciousness during that time, the six month count restarts. Check your state's driving laws and document in the patient's medical record that he or she has been advised of the local law and told to refrain from driving. Look to ICD-9 code V68.09 (Encounters for administrative purposes, other issue of medical certificates) in addition to the patient's seizure diagnosis, if the state requires your neurologist to submit a report regarding the patient's status.