Outpatient Facility Coding Alert

Question: We normally report video EEGs with codes 95951. Now our physician has ordered a four-day ambulatory EEG for a patient. How do we code this?

Texas Subscriber

Answer: You’ll use the same codes you’re accustomed to for in-office EEGs.

According to CPT® guidelines, “Codes 95950-95953 and 95956 are used per 24 hours of recording”, which means we can use these codes four times if procedure is performed for four days (i.e., once for each 24-hour period). Because of this instruction, you can submit 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) once for each of the four days.

Note: Medicare has a MUE limit of “1” for code 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). This would likely require physician documentation for the medical necessity for the prolonged monitoring if denied by the payer.

Don’t miss: These EEG procedures are paid under OPPS when performed in association with a hospital-based facility. They are not qualified ASC services for freestanding facilities.