Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that the provider performed an office evaluation and management (E/M) for an established patient that included low-level medical decision making (MDM) and lasted 36 minutes. Based on the E/M, the physician takes an extended electroencephalogram (EEG). Total EEG time was 80 minutes. Should I report 95812 x 2 for the EEG?

Texas Subscriber

Answer: No, you should not report 95812 (Electroencephalogram (EEG) extended monitoring; 41-60 minutes) x 2 in this scenario. On your claim, report:

• 95813 (… 61-119 minutes) for the EEG.
• 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) 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 99214 to indicate that a separate, significantly identifiable E/M occurred before the EEG.

Explanation: You would not report 95812 x 2 in this scenario because 95813 is more accurate for your time range.