Neurology & Pain Management Coding Alert

Follow our experts- advice on which is which -- and how you code them Performing electroencephalography (EEG) might be common for your neurologist, but correct coding still involves some sleuthing on your part. Follow these tips to ensure you correctly report routine or long-term EEGs or related services.

CPT 2007 divides EEG codes into two main categories: 95812-95830 for routine EEG and 95950-95962 for special EEG tests. 

Most of the codes are self-explanatory, but each section includes notes -- and other non-CPT resources -- to help keep your coding on track. Differences in Rules Guide Routine EEG Coding One of the biggest questions in EEG coding used to concern the -extended monitoring- codes: When did you shift from routine to extended (or long-term) monitoring? CPT answered that question a few years ago by stating specific timeframes for 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (- greater than one hour).

Important note: You can report 95812 or 95813 in place of 95816 (Electroencephalogram [EEG]; including recording awake and drowsy), 95819 (- including recording awake and asleep) or 95822 (- recording in coma or sleep only), but you cannot report them together.

Other questions still remain, however, about other aspects of coding routine EEGs. Brush up on your routine EEG coding with these insights from Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center in Shadyside:

Question 1: What is the minimum number of channels or electrodes the neurologist must use before reporting 95812 and 95813?

Answer 1: The physician must meet the minimum technical standards for an EEG test. This includes a minimum of 20 minutes of monitoring, plus at least eight channels and other rules as set forth by national organizations such as the American Clinical Neurophysiology Society (www.acns.org). Many physicians use more than eight channels nowadays, thanks to newer technology, says Marianne Wink-Sturgeon, RHIT, CPC, ACS-EM, of the University of Rochester Medical Center's neurology department. Note: This same advice applies to 95822 and 95955 (Electroencephalogram [EEG] during nonintracranial surgery [e.g., carotid surgery]).

Question 2: What is the difference between codes 95816 and 95819?

Answer 2: The patient must have fallen asleep before you can report 95819. If she doesn-t, you should submit 95816 instead. The line between -drowsy- and -asleep,- however, can often be difficult to determine. Some coders say you can report 95819 if your neurologist intended to conduct a sleep study but the patient did not obtain sleep, despite the technician's best efforts.

But Sturgeon-Wink warns against this strategy. -Your physician could intend to perform any procedure, but to bill it on intention would be a big compliance issue,- she says. [...]