Neurology & Pain Management Coding Alert

Question: How should we code if the neurologist provides monitoring for localization of cerebral seizures (95951) for less than 24 hours? Should we append modifier -52 to indicate a reduced service?

Ohio Subscriber

Answer: The question is: For how much less than 24 hours did the neurologist monitor the patient?

Most carriers allow full payment for 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) if the physician monitors the patient for at least 15 hours and up to 30 hours.

For services of nine to 15 hours, you should report 95951 with modifier -52 (Reduced services) to indicate that the neurologist reduced the service as described by CPT.

For anything less than nine hours, you should consider an alternative to 95951. The best choice is probably 95813 (EEG extended monitoring; greater than one hour).

Always heed your insurers' advice: If an insurer tells you that you can report 95951 for any time limits other than those listed above, be sure to get their policy in writing (particularly if they say they allow billing this code for services less than nine hours).

Note: The EEG society now is working to allow payment for 95951 for 12 hours or more of monitoring, but to date payers have not reached a consensus of agreement. Neurology Coding Alert will keep you up-to-date of any changes.

 - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.