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Neurology & Pain Management Coding Alert

Reader Question:

Verify Details Before Using 95812

Published on Sat Jan 27, 2007

Question: Should we report 95812 or 95816 for an EEG obtained in the awake state only? Wisconsin Subscriber Answer: Code 95816 (Electroencephalogram [EEG]; including recording awake and drowsy) is specifically for patients who are awake and drowsy during testing. Code 95812 (Electroencephalogram [EEG] extended monitoring; 41 to 60 minutes), however, is for a certain timeframe regardless of whether the patient slept. If the test stretched to the timeframe represented by 95812, report it -- with caution. Many carrier guidelines state that 95812 cannot be the patient's first EEG because you must establish medical necessity before performing an extended EEG. Codes appropriate for first-time EEGs include 95816, 95819 (- including recording awake and asleep) and 95822 (- recording in coma or sleep only).
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