Take a Closer Look at Digital EEG Analysis
Published on Sat Jan 01, 2005
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Don't be confused by out-of-date guidelines: Guidelines published in the winter 1994 CPT Assistant specified that you should report 95957 only in addition to 95816 (Electroencephalogram [EEG];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 [...]
