Neurology & Pain Management Coding Alert

When reporting electroencephalographic (EEG) seizure monitoring, neurologists and neurology coders must be careful to assign not only the proper CPT code(s), but also to document appropriate diagnoses to legitimize the claim. By gaining a better understanding of the diagnoses involved and listing all appropriate signs and symptoms, you can better ensure proper payment. 1. Select the Procedure Patients undergo EEG monitoring to determine the reasons for seizures and to localize the portion of the brain affected. For patients with specific seizure activity, the most common EEG monitoring procedures are 95950 (Monitoring for identification and lateral-ization of cerebral seizure focus, electroencephalographic [e.g., 8 channel EEG] recording and interpretation, each 24 hours) and 95951 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electro-encephalographic [EEG] and video recording and interpretation [e.g., for presurgical localization], each 24 hours). A related procedure, 95953 ( by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours) more precisely localizes certain types of seizures and, if employed, generally follows monitoring as described by 95950 or 95951.

CMS guidelines specify that 95950-95953 must be performed under the general supervision of a physician in all cases. This means the procedure "is furnished under the physician's overall direction and control but that the physician's presence is not required during the performance of the test. The physician remains responsible for the non-physician personnel performing the procedure."

Lastly, because the descriptors for 95950-95953 specify "each 24 hours," if fewer than 24 hours are provided, report the appropriate CPT code with modifier -52 (Reduced services) appended, advises Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine. Do not reduce your fee: Be sure to indicate the total number of hours of monitoring provided and allow the payer to make the adjustment. For patients with less well-defined seizure activity, the neurologist may instead choose a procedure from the range 95812-95827. Of these, the most frequently performed are 95812 (Electroencephalogram [EEG] extended monitoring; up to one hour) and 95813 (greater than one hour), as well as 95816 (Electroencephalogram [EEG] including recording awake and drowsy [including hyperventilation and/or photic stimulation when appropriate]) and 95819 ( including recording awake and asleep). Note that hyperventilation and photic stimulation are not a mandatory part of 95816/95819. Rather, "the neurologist need perform these services only when medically appropriate and not otherwise contraindicated," Busis says. Additionally, 95819 is appropriate if an awake/asleep study was intended even if the patient [...]