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Consider the patient’s consciousness status before selecting a code.

When the provider performs an electroencephalogram (EEG), you won’t have just one or two codes to choose from. In fact, you’ll be faced with a wide range of options that will require you to scrutinize the provider’s documentation, look for how much time was spent performing the service, and evaluate whether the patient was awake, drowsy, or asleep.

Check out a few tips that will help you select the most accurate EEG code every time.

Know What EEGs Test for

When the provider has concerns that a patient may have a brain disorder or neurological condition, they might order an EEG test. It evaluates electrical activity in the brain to identify and detect brain waves. The provider will then read the findings to help diagnose the patient.

For example, if the provider finds frequent spikes in brain waves, the patient may have a seizure disorder. If they discover extremely slow brain waves, the patient may have a brain tumor or could have experienced a stroke.

Medicare will reimburse EEG claims for dozens of diagnoses, covering signs and symptoms as well as confirmed conditions. Check out this partial list of >EEG-related diagnosis codes:

• G40.111 (Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus)
• G40.833 (Dravet syndrome, intractable, with status epilepticus)
• G93.6 (Cerebral edema)
• H55.00 (Unspecified nystagmus)
• I60.8 (Other nontraumatic subarachnoid hemorrhage)
• S06.37AA (Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, initial encounter)

If the patient doesn’t yet have a diagnosis, you should always report the signs or symptoms that prompted the test, such as a code for frequent headaches or a head injury.

As with any other service, you should never select a diagnosis code simply because the payer covers it. Always choose the ICD-10-CM code based on the documentation. If the reason that the provider ordered or performed the EEG isn’t clear in the documentation, query the provider for further details so you can select a code.

Know Differences in Procedure Codes

The first step in selecting a CPT^® code is to determine whether the patient had a routine EEG or an ambulatory EEG.

Here’s the difference: During a routine EEG, the test is typically performed for about 30 to 120 minutes to record the patient’s brain activity. An ambulatory EEG, however, takes place at home for an extended period, often up to 72 hours, using a portable device. Ambulatory EEG codes are selected from the CPT^® Long-term EEG Setup and Monitoring series (95700-95726) based on whether the provider performed setup, interpretation, or writing the report.

Most payers won’t reimburse you for an ambulatory EEG unless you have already performed a routine EEG. Routine EEGs are reported with codes from the CPT^® Routine Electroencephalography (EEG) series (95812-95822). You’ll choose the right code depending on how much time the EEG monitoring takes or the state of the test.

Identify Awake vs. Asleep EEGs

You’ll notice that the descriptors for codes in the 95816-95822 series refer to the patient’s level of consciousness as follows:

Awake and drowsy: If the physician monitors the patient during awake and drowsy portions of the procedure, you’ll report 95816 (Electroencephalogram (EEG); including recording awake and drowsy). During this procedure, the patient is stimulated, both fully awake and mildly sedated. This helps verify whether the patient is experiencing the same symptoms while alert and when sedated.

Awake and asleep: When encounter notes indicate that the patient was awake and asleep, you’d report 95819 (Electroencephalogram (EEG); including recording awake and asleep). During these EEGs, the patient is awake and then completely asleep during the same test. This allows the provider to identify specific circumstances of abnormal brain waves that may arise while the patient is sleeping versus awake.

Asleep only: If the physician documents that they performed the EEG while the patient was in a coma or asleep, you’d choose 95822 (Electroencephalogram (EEG); recording in coma or sleep only). In this situation, the patient is in a deep coma or is completely asleep the entire time. This allows the provider to identify whether the patient is having active brain wave patterns or is in the process of brain death.

What about 95824? If the provider performs an EEG solely to confirm whether a patient is brain dead, you’ll report 95824 (Electroencephalogram (EEG); cerebral death evaluation only).

Remember These Codes for Extended Monitoring

There are time-based codes you’ll report for extended EEG monitoring, meaning the provider spends more time than usual on the EEG. You can report the following codes as long as the provider documents how much recording time is spent; these codes are not dependent on whether the patient is awake or asleep:

• 95812 (Electroencephalogram (EEG) extended monitoring; 41-60 minutes)
• 95813 (… 61-119 minutes)

You can never report these codes along with the 95816-95822 series. Instead, you must select a code from one set or the other. When choosing an extended EEG code, the clock is all that matters. Whether your physician is recording awake/drowsy, awake/asleep, asleep/coma, you’ll choose 95812 or 95813.

Check Out These EEG Examples

To nail down the right code for EEG services, review these quick examples:

Example 1: The neurologist performs an EEG for a patient with cerebral edema who is awake for the first half, and then asleep for the second half. The documentation indicates the service lasts 35 minutes. For this EEG, you’d report 95819, along with ICD-10-CM code G93.6.

Example 2: The neurologist performs an EEG for 75 minutes to evaluate a sleeping patient with a subarachnoid hemorrhage. For this encounter, you’d report 95813 along with diagnosis code I60.8.

Torrey Kim, Contributing Writer, Raleigh, NC