Neurology & Pain Management Coding Alert

You can report 95957 with 95951/95953, but meeting the requirements may be tougher than you think

Don't be tempted to report digital EEG analysis (95957) every time the neurologist interprets an electroencephalograph. Digital analysis represents a significant additional service, and documentation must show medical necessity to avoid denials.

Without Additional Analysis, Skip 95957

True digital analysis as described by 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]) requires that the neurologist or technologist conduct the analysis using quantitative analytical techniques such as data selection, quantitative software processing, and dipole source analysis.
 
This kind of analysis generally entails additional work by the neurologist or technician (up to an hour or more) to process the data from the digital EEG, as well as an extra 15-45 minutes of physician time to review the data.
 
Coding tip: If you can find no evidence of this type of work in the physician's documentation, then most likely digital EEG analysis did not occur.
 
Don't let the word "digital" fool you: Most neurologists run EEGs on digital machines, but using a digital recorder alone does not qualify the test for submission of 95957, says Gregory L. Barkley, MD, medical director of the comprehensive epilepsy program at the Henry Ford Health System in Detroit.
 
Digital recording uses a digital EEG recorder but is digital only to the extent that the neurologist doesn't use an analog paper recorder at the time of wave-form capture. This represents a typical EEG interpretation in most clinical situations, and you should report this using only the appropriate EEG code (for instance, 95822, Electro-encephalogram [EEG]; recording in coma or sleep only).
 
The bottom line: You should report 95957 only when the technologist and/or physician provides additional work for analysis of some features of the EEG (typically, three-dimensional spike localization).

You Can Report 95957 With Most EEGs

With proper documentation, you may report 95957 with most EEG codes, including 95812-95827 and 95950-95956.
 
Don't be confused by out-of-date guidelines: Guidelines published in the winter 1994 CPT Assistant specified that you should report 95957 only in addition to 95816 (Electroencephalogram [EEG];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]).
 
Although CPT Assistant has not printed an update (and although Neurology Coding Alert has cited these instructions as recently as November 2004), these guidelines no longer apply.
 
"The winter '94 instructions are out-of-date," says Anne M. Dunne, RN, MBA, MSCN, practice administrator for South Shore Neurologic Associates PC/Brookhaven MRI, in Bay Shore, N.Y. "Neither CPT nor the National Correct Coding Initiative prohibits reporting digital EEG analysis with 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], 95953 [Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electro-encephalographic (EEG) recording and interpretation, each 24 hours] or any other specific EEG procedure."
 
For example: The neurologist orders extended EEG monitoring with video recording for an epileptic patient. Following acquisition of the data, the neurologist uses digital analysis to identify more precisely seizure spikes. In this case, you may report both 95953 and 95957.

Show That Analysis Affects Care
 
You must provide medical necessity to report 95957, and the physician must supply evidence to demonstrate that the results will affect patient management directly. "Medicare and third-party payers will reimburse for digital EEG analysis, but not indiscriminately," Dunne says.
 
For example: EEG results are critical in the surgical treatment of epilepsy. A patient's seizures may be pronounced and easily recognized, or they may occur in a matter of seconds and be difficult to detect. The neurologist may place such a patient on an EEG machine for an extended period during a seizure cycle, which may last for hours or even days.
 
Digital analysis of the EEG results will enhance the clinician's ability to identify abnormal spikes, rhythmic discharges, epileptiform activity and localization of discharges, Dunne says. "The digital analysis will also distinguish seizures from pseudo-seizures and determine the types of seizures - which ultimately will have a profound effect in the selection of antiepileptic medications."
 
If in doubt, ask the payer: If you have concerns whether an insurer will cover 95957 for a given diagnosis, you should contact the insurer for preauthorization.