Neurology & Pain Management Coding Alert

Question: One of our neurologists performs overnight electroencephalograms (EEGs) in the hospital setting. He monitors the patient throughout the day and overnight for approximately 24 hours. How should we code this considering the monitoring covers portions of two calendar days? 

Washington Subscriber Answer: The test's 24-hour timeframe begins when the test starts, not according to the 24-hour clock time.

Example 1: If a test begins at 9 a.m. on Monday and ends at 9 a.m. on Tuesday, that is the first 24 hours. Report 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). Append modifier 26 (Professional component) because the hospital owns the equipment your neurologist uses.

Example 2: If the test starts at 9 a.m. on Monday and runs until 2 p.m. on Wednesday, you-ve passed the first 24-hour period. Report 95951-26 for Monday, 95951-26 for Tuesday, and 95813 (Electroencephalogram [EEG] extended monitoring; greater than one hour) with modifier 26 for Wednesday.

Explanation: You cannot bill for a 24-hour video EEG on Wednesday because the test was only for five hours of that day. That's why you report extended monitoring instead.