Neurosurgery Coding Alert

Remember: Always pay attention to modifier indicators.

You’ve learned all about the 2020 CPT^® electroencephalogram (EEG) and electroencephalogram with video (VEEG) additions, changes, and revisions in recent issues of Neurosurgery Coding Alert. Now, with the release of the Correct Coding Initiative (CCI) 26.0 procedure-to-procedure (PTP) edits, you should also learn how these edits will impact your neurosurgery’s practice’s reimbursement this year.

As is typical of the first round of bundlings for a new year, many of the CCI 26.0 edits focus on the new 2020 CPT^® codes.

Explore Multiple Edits for New Long-Term EEG Setup Code 95700

You’ll see many new edits involving new long-term EEG setup code 95700 (Electroencephalogram (EEG) continuous recording, with video when performed, setup, patient education, and takedown when performed, administered in person by EEG technologist, minimum of 8 channels).

Codes bundled into 95700 with a modifier indicator of “0” include the following: collection of a blood specimen codes 36591 and 36592; irrigation of implanted venous access device code 96523; and remote monitoring of physiologic parameter codes 99453 and 99454.

These edits have a modifier indicator of “0,” which means you cannot break the edit under any circumstances.

You will also see some codes bundled into 95700 with a modifier indicator of “1.”

Codes bundled into 95700 with a modifier indicator of 1 include the following: +95940 (Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)) and G0453 (Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)).

“Keep in mind that although this edit allows reporting 95700 with intraoperative neurophysiological monitoring procedures, an EEG procedure (including those listed below) would only be reportable if it is performed as a baseline procedure before intraoperative monitoring begins,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.  “Codes +95940, +95941 and HCPCS G0453 include all neurophysiological monitoring during the procedure.”

Don’t miss: A modifier indicator of “1” lets you know that an edit can be overcome, if appropriate, with the use of a modifier, such as modifier 59. However, you should not use modifier 59 and other CCI-associated modifiers to bypass a CCI edit unless you meet the proper criteria for the use of the modifier. The documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that you use.

Reminder: “Before immediately appending modifier 59, always review the modifier lists for a more appropriate/specific modifier,” says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. “It is extremely important to use the X{E, S, P, U} modifiers accordingly.”

On the other hand, make sure you take note of the codes 95700 is bundled into with a modifier indicator of 0: anesthesia codes 00100-00190; routine EEG codes 95812-95824; and digital analysis of EEG code 95957.

And, take a look at the codes 95700 is bundled into with a modifier indicator of 1: polysomnography code 95782; special EEG codes 95955 and 95958; and home sleep study codes G0398-G0400.

Observe New EEG Technologist Edits

You will see many new edits involving the new long-term EEG monitoring codes you report if your practice uses an EEG technologist. These codes are as follows:

• 95705 (Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist, 2-12 hours; unmonitored)-95710 (Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist, each increment of 12-26 hours; with continuous, real-time monitoring and maintenance)
• 95711 (Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, 2-12 hours; unmonitored)-95716 (Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; with continuous, real-time monitoring and maintenance)

For example, take a look at a sampling of the edits you can expect with these codes.

Codes bundled into 95705-95716 with a modifier indicator of “0” include the following: 36591, and 36592; 96523; and 99453 and 99454.

Codes bundled into 95705-95716 with a modifier indicator of “1” include the following: 95824; 95940; G0453.

Dig Into Brand-New Continuous Recording EEG Edits

You should also notice the edits you see with new continuous recording EEG codes 95717 (Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation and report, 2-12 hours of EEG recording; without video)-95726 (Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of EEG recording, with video (VEEG)).

The following codes are bundled into 95717-95726 with a modifier indicator of “0”: 36591 and 36592; 96523; and 99453 and 99454.
The following codes are bundled into 95717-95726 with a modifier indicator of “1”: 95824; 95940; and G0453.

On the other hand, you will also see edit pairs where 95717-95726 are bundled into Column 1 codes. For example, 95717-95726 are bundled into codes 00100-00190 with a modifier indicator of “0.”

And, you will also see where 95717-95726 are bundled into code 95958 with a modifier indicator of “1.”