Neurology & Pain Management Coding Alert

Question: I work for a neurologist who reprogrammed a patient’s VNS (vagus nerve stimulator). Then he did an EEG on the same day as the reprogramming to see if the patient had epileptic seizures. I thought if the patient had a VNS it is because he has epilepsy or epileptic seizures. I would like to verify that it is correct to do an EEG on the same day that the patient has a VNS. Are the services acceptable and can codes 95974 and 95816 be billed together?

Washington Subscriber

Answer: The most recent Correct Coding Initiative (CCI) edits do allow you to report 95816 (Electroencephalogram [EEG]; including recording awake and drowsy) with 95974 (Electronic analysis of implanted neurostimulator pulse generator system [e.g., rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements]; complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour). However, individual payers might have different policies regarding what services can be performed or billed together. Check with the payer in question to verify their stance on 95816 and 95974.

Remember: Code 95974 for programming is a time-based code that requires supporting documentation of time. The CPT^® guidelines indicate, “For 95972, 95974, and 95978, use modifier 52 if less than 31 minutes in duration.”