Neurology & Pain Management Coding Alert

Question: How should I report video EEG? I've had trouble with these claims facing denial. Could this be a problem with the diagnosis?


Michigan Subscriber

Answer: You should report a video electro-encephalograph (EEG), also known as video EEG monitoring (VEM), 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).

VEM monitors a patient's behavior and his brain electrical activity, using dedicated equipment that simultaneously records EEG, video and sound. This is useful, for instance, to distinguish epileptic seizures from conditions that may mimic epileptic seizures, to determine the type or types of seizures that the patient has, or to localize the portion of the brain in which the seizures are arising.

Most Medicare carriers cover ambulatory or 24-hour (EEG) monitoring (including 95950-95951, 95953 and 95956) "for patients in whom a seizure diathesis is suspected but not defined by history, physical or resting EEG," according to a typical Medicare carrier review policy. Examples of covered diagnoses include:

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.
 
Individual carriers may specify different guidelines, and you should contact your individual payer for a complete list of allowable ICD-9 codes.

In addition, many providers bundle video EEG to sleep studies (95805-95811). Therefore, you should not report 95951 separately when billing for sleep studies.