Neurology & Pain Management Coding Alert

Anything under 12 hours calls for 95951-52

The AMA now says that if you are reporting 95951 for fewer than 12 hours of monitoring, you should append modifier -52 (Reduced services) to denote a less-than-complete service.

If the recording time is 12 hours or more, you need not call on modifier -52.

The 12-hour guideline came in the form of a "Question and Answer" printed in the December 2004 CPT Assistant. This represents a change in policy for the AMA, which has stated in the past (for example, CPT Assistant, March 2003) that 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) describes services up to 24 hours, and therefore no modifiers were necessary for fewer than 24 hours of monitoring.

The AMA's new position also brings it into closer alignment (but not full agreement) with the American Clinical Neurophysiology Society, which has long recommended appending modifier -52 for any extended monitoring services lasting fewer than 15 hours.

Learn more: For complete information on the American Clinical Neurophysiology Society's suggestions for reporting 95951, see "Your 4 Most Common EEG Questions Answered," Neurology Coding Alert, February 2005.

Because Medicare has not taken a stand on this issue, individual payers may still impose their own guidelines for reporting 95951, but the AMA's recommendation may bring some much-needed standardization to this area.