Neurology & Pain Management Coding Alert

Get the scoop on using 95953 for tests under 24 hours The key insights into electroencephalography (EEG) coding and its effect on reimbursement are easier to understand than you think. Our experts help guide you through the process. Start With the ABCs of EEG For coding success, the first thing you need is a concise yet informative report to base your coding decisions on. You also need to be informed about the elements that make up the EEG codes.- "For example, some of the things you need to consider are whether the patient was asleep, awake or both during the procedure," says Lynn McCormack, CPC, with HCA Physician Services in Las Vegas. "How long was the study performed for? Was there video recorded during the procedure? All of this information should be in your report. Once you have the answers to these questions, you are on your way to finding the appropriate code." Here's what you need to know. Pitfall 1: Be Aware of Minimum Testing Requirements Neurologists must meet certain minimum technical standards for administering an EEG test. These include the following: - at least 20 minutes of monitoring - a minimum of eight channels. Experts note that, due to technological advances, many physicians now use more than eight channels during testing. Tip: National organizations, such as the American Clinical Neurophysiology Society (www.acns.org), have established additional rules, so be sure your practice knows which standards it needs to meet. Reminder: These criteria apply to 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (- greater than one hour), as well as 95822 (Electroencephalogram [EEG]; recording in coma or sleep only) and 95955 (Electroencephalogram [EEG] during nonintracranial surgery [e.g., carotid surgery]). Pitfall 2: Differentiate Between 95816 and 95819 When you-re coding for a patient who was not fully conscious throughout a test, using 95816 (Electroencephalogram [EEG]; including recording awake and drowsy) and 95819 (- including recording awake and asleep) can raise a lot of questions. There can be a fine line between "drowsy" and "asleep." What to do: You can only report 95819 if documentation shows that the patient fell asleep. If the patient didn't fall asleep, you should submit 95816. For example: Your neurologist administers an EEG that lasts for 25 minutes. You check the documentation and find that during the testing, the patient came close to losing consciousness, but that she never actually fell asleep. In this situation, your correct coding choice would be 95816. Side note: Some coders have suggested that reporting 95819 is legitimate if your neurologist intended to conduct a sleep study but the patient did not actually fall asleep, despite the technician's best efforts. Experts note, however, that billing based on a physician's "intention" [...]