Neurology & Pain Management Coding Alert

Here's why the patient's consciousness matters during EEGs.

When patients report to your practice for electroencephalography (EEG) testing, you'll most likely choose a code representing one of the "routine" EEGs.

Caveat: Which code you should choose in which situation isn't cut and dried. It will depend on very specific details, including patient status during the entire test and total test time.

Be ready for any and all EEG coding challenges that come through your door with this EEG FAQ:

Q: What are some patient conditions that might warrant an EEG?

A: According to Amy C. Pritchett, BSHA, CPC, CPMA, CPCI-I, CRC, CANPC, CASCC, CEDC, CCS, CMDP, CMPM, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS, a coding consultant and 2015 president of the American Academy of Professional Coders chapter in Mobile, Ala., patients suspected of having one of the following conditions might need an EEG:

• frequent headaches,
• brain lesions,
• Alzheimer's disease,
• psychoses,
• narcolepsy,
• traumatic brain injury (TBI), or
• drug intoxication.

These are not, however, the only reasons a patient might need an EEG. The above list includes only a few conditions that you might evaluate with an EEG.

Example: A patient has a routine EEG due to suspicion of a brain lesion or cyst. The EEG confirms the presence of an arachnoid cyst. On the claim, you'd include ICD-10 code G93.0 (Cerebral cysts) to represent the patient's lesion.

Q: What is the difference between "awake," "drowsy," "asleep," and "coma"?

The most befuddling aspect of choosing the correct EEG code is the descriptor. You'll have to know the EEG patient's state of consciousness for the entire procedure in order to choose the correct code. Here's Pritchett's take on the definition of these patient statuses:

If the physician performs the EEG while the patient is awake and drowsy, you'll report 95816 (Electroencephalogram [EEG]); including recording awake and drowsy).

Details: During a 95816 EEG, the physician monitors the patient during awake and drowsy portions of the procedure.  "The patient is stimulated during the procedure, both fully awake and mildly sedated [drowsy]. This is to verify if the patient is experiencing the same symptoms during alertness and when sedated," Pritchett explains.

When encounter notes indicate that the patient was awake and asleep, you'd report 95819 (... including recording awake and asleep). "In this procedure, the patient is completely asleep after performance of an EEG while awake," Pritchett explains. The physician conducts an awake and asleep EEG because she is "looking for certain characteristics of abnormal activity to arise between both awake and sleeping patterns," says Pritchett.

If the physician documents that she performed the EEG while the patient was in a coma or asleep, you'd choose 95822 (... recording in coma or sleep only). "In this procedure, the patient is fully asleep or in a deep coma," explains Pritchett. The physician performs the EEG in coma/sleep only "to verify if the patient is having active brain wave patterns during abnormalities of sleep, or in the process of brain death," she says.

Q: When would you use extended EEG codes?

A: Here's where EEG coding can confuse anyone. The base codes for 95816-95822 include 20 to 40 minutes of recording time. If the physician records between 41 and 60 minutes of EEG time, you'd report 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes). When the EEG recording time exceeds 60 minutes, opt instead for 95813 (... greater than 1 hour).

When choosing an extended EEG code, the clock is all that matters. Whether your physician is recording awake/drowsy, awake/asleep, asleep/coma, you'll choose from 95812 and 95813.

Example: Notes indicate that the physician performed an awake/drowsy EEG that lasted 48 minutes. You would report 95812 for the service rather than 95816.

Q: Is it possible to report an EEG with a separate E/M service?

A: Sometimes. If the patient reports for a scheduled EEG, then it's highly unlikely that the physician performs a significant, separately reportable evaluation and management (E/M) service along with the test.

Exception: If the patient reports with a complaint and the physician conducts a full E/M before making the EEG decision, then a separate E/M might be reportable.

Let's say an established patient reports to the physician complaining of headaches. The physician performs a problem-focused history and an expanded problem-focused exam; notes indicate low-complexity medical decision-making (MDM). Then, the physician conducts an awake/asleep EEG that lasts 37 minutes. 

On the claim, you'd report:

• 95819 for the EEG
• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity) for the E/M service
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to 99213 to show that the E/M service was separately identifiable from the EEG service
• R51 (Headache) appended to 95819 and 99213 to represent the patient's headache.