Neurology & Pain Management Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Our office has a digital electroencephalogram (EEG) machine, but not every test run with this unit uses its digital analysis functions. Under what circumstances is it appropriate to bill 95957 (digital analysis of EEG)? Do I have to run a specific program digitally analyzing EEG waves or is the very fact that I am using a digital machine for EEG data acquisition enough to qualify for reimbursement with this code?

Anonymous Texas Subscriber


Answer: Code 95957 should not be billed unless actual digital analysis is performed. EEGs are used to diagnose such diverse disorders as dementia, mental retardation, epilepsy and sleep-related disorders. Digital analysis of EEG should be performed only when it is medically necessary.

For example, EEG results are critical in the surgical treatment of epilepsy. A patients seizures may be very pronounced and easily recognized or occur in a matter of seconds and can be easily missed. Patients may be placed on an EEG machine for an extended period of time during a seizure cycle. This may last for hours or even days. A non-digital analysis EEG will report when seizures occur, but it will not specify their point of origin in the brain. A digital analysis would be required for three-dimensional localization of a seizure spike in a patient who might be a surgical candidate.

Computer-based programs are available to differentiate whether a spike is more likely to occur in the medial versus the lateral portion of the brain, and this information may have some influence on the nature of the patients surgery. In that case, it is necessary for the EEG technician to spend an extra 30 to 60 minutes with a non-digital analysis EEG flagging spikes for further study and for the physician to spend a similar amount of time to assure that the flagged spikes are correct. Then the digital analysis EEG, computer programmed spike localization, is performed, and the physician interprets the results to mark the most likely areas for surgery. Under these circumstances, it is appropriate to bill 95957.

Editors note: The answer to this question was provided by Marc R. Nuwer, MD, PhD, of Los Angeles, a CPT advisor from the American Academy of Neurology; president, International Federation of Clinical Neurophysiology, 1997-2001; and professor of neurology at UCLA.