Neurology & Pain Management Coding Alert

Question: My physician recently provided a level-one initial hospital care service to a patient, along with a 43-minute electroencephalogram (EEG). We reported 99221 for the E/M and 95812 for the EEG. I just got a denial for the claim; the payer reimbursed us for 99221, but not 95812. Is this correct? Or should I resubmit the claim?

South Carolina Subscriber

Answer: You should definitely resubmit the claim — just remember modifier 26 (Professional component) on your resubmission. On the claim, report:

• 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) for the EEG with modifier 26 (Professional component) appended
• 99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity…) for the hospital service.

Explanation: When you use a facility’s equipment to perform an EEG, you can only code for the professional portion of the service; hence, the need for modifier 26 on your claim. The hospital will also report 95812 for the EEG — with modifier TC (Technical component) appended to show that they are not coding for the professional portion of the service.

Good idea: When you resubmit the claim, include separate notes detailing the hospital visit and the EEG results.