Neurology & Pain Management Coding Alert

Question: I have never billed for a video EEG for a patient in the hospital. What is the appropriate CPT code? Is there need for a specific diagnosis? Discussion Group Participant Answer: Video electroencephalograph (EEG), also known as video EEG monitoring (VEM), may be reported using 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) Without video, use 95956. According to CMS guidelines, the procedure must be performed under a physician's general supervision (i.e., the procedure is furnished under the physician's overall direction and control, but his or her presence is not required during the procedure). VEM simultaneously monitors a patient's behavior and brain electrical activity, using dedicated equipment that records EEG, video and sound onto a computer for later analysis. In contrast to routine EEG recordings which are normally performed between episodes VEM seeks to record the patient's EEG and behavior during episodes. This is useful, for instance, to distinguish epileptic seizures from conditions that may mimic epileptic seizures, to determine the type or types of seizures from which the patient suffers, or to localize the portion of the brain in which the seizures are arising. Most Medicare carriers cover ambulatory or 24-hour (EEG) monitoring (e.g., 95950-95951, 95953, 95956), "for patients in whom a seizure diathesis is suspected but not defined by history, physical or resting EEG," according to a Florida Medicare Part B carrier local medical review policy. Individual carriers maintain a list of specifically allowable ICD-9 codes for these procedures. Here's a partial listing of payable ICD-9 codes (contact your carrier for a complete list):

013.xx Tuberculous/tuberculoma 036.0-036.1 Meningococcal meningitis or encephalitis 191.0-192.x Malignant neoplasm, various 225.0-225.2 Benign neoplasm, various 292.81-292.89 Other specified drug-induced mental disorders 293.0-293.1 Delirium, acute or subacute 295.20-295.24 Schizophrenic disorders 332.0-332.1 Parkinson's disease 337.0-337.9 Disorders of the autonomic nervous system 340 Multiple sclerosis 345.90-345.91 Epilepsy, unspecified 346.xx Migraine 350.1-350.9 Trigeminal nerve disorders 854.xx Intracranial injury. Many providers bundle video EEG to sleep studies (95805-95811). Therefore, 95951 should not be reported separately when billing for procedures in the 95805-95811 code range.