Neurology & Pain Management Coding Alert

Question: Our provider performed an electroencephalogram (EEG) recently, and I was thinking I would report the service with 95953. Notes indicate that the EEG was to localize a cerebral seizure focus using a computerized 16-channel EEG. I am concerned, however, since notes indicate that the EEG only lasted 11 hours. Should I change my coding strategy?

Virginia Subscriber

Answer: Don’t change your strategy — but do remember to include a reduced services modifier on the claim.

For the EEG, you should report 95953 (Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic [EEG] recording and interpretation, each 24 hours, unattended). Then, append modifier 52 (Reduced services) to 95953 to show that you are coding for less than 12 hours of EEG.

Evidence: According to the descriptor preceding the “Special EEG Tests” section, CPT^® states: “For recording more than 12 hours, do not use modifier 52. For recording 12 hours or less, use modifier 52.”

You should use these modifier 52 rules for 95953, as well as these other special EEG codes:

• 95950, Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic (e.g., 8 channel EEG) recording and interpretation, each 24 hours
• 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
• 95956, Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technologist or nurse.