Neurology & Pain Management Coding Alert

Answer: The descriptor for 95951 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalo-graphic [EEG] and video recording and interpretation [e.g., for presurgical localization ...) specifies "each 24 hours." You may report multiple units of 95951 if appropriate, but CPT contains no code to report "each additional" hour(s). Therefore, for fewer than 24 hours report 95951 with modifier -52 (Reduced services) appended. File the claim manually and include explanatory documentation noting the exact number of hours of monitoring provided. In this case, for instance, the practice provided a total of 82 hours of monitoring (3 x 24 + 10 = 82). Report the service using 95951 x 3, 95951-52. Your documentation should specify that you are claiming three "whole" units and one "partial" unit of 24-hour monitoring.

Do not reduce your fee for procedures to which you append modifier -52. Many payers automatically lower payment for modifier -52 claims. If you prorate your services, the insurer may further, inappropriately reduce reimbursement. Rather, charge your regular fee and allow the insurer to make a payment determination based on the documentation you provide.