Neurology & Pain Management Coding Alert

Question: We recently submitted a claim for 95951. Our billing service states that they cannot bill without the monitoring report. Is this true?


California Subscriber
 

Answer: Because 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) specifies "each 24 hours," the billing service may be requesting the report to verify the number of hours of monitoring.

Some payers may require the report as part of submitting documentation, or the billing company may simply want the report on hand for follow-up if the claim is denied. Nothing in CPT or CMS regulations specifically states that a monitoring report is necessary when filing a claim for 95951, however.
 
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.