Advanced Search

Neurology & Pain Management Coding Alert

You Be The Coder:

For Awake and Drowsy, Turn to 95816

Published on Thu Apr 22, 2004

Question: I perform all my EEGs in the local hospital. Which code should I use for reading (only) the EEG in awake and drowsy state? I have received denials for 95819.

New Jersey Subscriber

Answer: The descriptor for electroencephalogram (EEG) code 95819 specifies "including recording awake and asleep." Because you indicate the patient is awake and drowsy (rather than asleep), the more appropriate choice is 95816 (Electroencephalogram [EEG]; including recording awake and drowsy). These codes also include hyperventilation and/or photic stimulation when appropriate, and reporting times of 20-40 minutes, according to CPT.

Because you are reading the results only, you should append modifier -26 (Professional component) to 95816. This allows you to recoup payment for your work, but allows the hospital to bill separately for the procedure's technical component.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Neurology & Pain Management Coding Alert

View All