Neurosurgery Coding Alert

Here’s why the patient’s consciousness matters during EEGs.

When patients report to your practice for electroencephalography (EEG) testing, you’ll most likely choose a code representing one of the “routine” EEGs.

However, it isn’t always clear which code you should use. In order to make the correct coding choice, you’ll need details like patient status during the entire test and total test time. There are also a set of relatively new continuous long-term EEG codes that you’ll need to be aware of.

Take a look at this expert advice on EEGs and take on all coding challenges with confidence.

These Symptoms Might Warrant EEG

According to Amy Pritchett, CCS, CPC-I, CPMA, CDEO, CASCC, CANPC, CRC, CDEC, CMPM, C-AHI, senior consultant at Pinnacle Enterprise Risk Consulting Services LLC in Centennial, Colorado, patients suspected of having one of the following conditions might need an EEG:

• Frequent headaches
• Brain lesions
• Alzheimer’s disease
• Psychoses
• Narcolepsy
• Traumatic brain injury (TBI)
• Drug intoxication

These are not, however, the only reasons a patient might need an EEG. The above list includes only a few conditions that you might evaluate with an EEG.

Example: A patient has a routine EEG due to suspicion of seizures related to a brain lesion or cyst. The EEG confirms the presence of an epileptogenic focus attributable to an arachnoid cyst seen on MRI. On the claim, you’d include ICD-10 code G93.0 (Cerebral cysts) to represent the patient’s lesion and the type of seizure activity the individual has.

Know Awake/Drowsy/Asleep/Coma Definitions

Once you get into the actual descriptors for the EEG codes, things can get confusing quickly—unless you have the information you need before coding.

Why? You’ll have to know the EEG patient’s state of consciousness for the entire procedure in order to choose the correct code. Here’s Pritchett’s take on the definition of these patient statuses:

If the physician performs the EEG while the patient is awake and drowsy, you’ll report 95816 (Electroencephalogram [EEG]); including recording awake and drowsy).

During a 95816 EEG, the physician monitors the patient during awake and drowsy portions of the procedure. “The patient is stimulated during the procedure, both fully awake and mildly sedated [drowsy]. This is to verify if the patient is experiencing the same symptoms during alertness and when sedated,” Pritchett explains.

When encounter notes indicate that the patient was awake and asleep, you’d report 95819 (... including recording awake and asleep). “In this procedure, the patient is completely asleep after performance of an EEG while awake,” Pritchett explains. The physician conducts an awake and asleep EEG because they are“looking for certain characteristics of abnormal activity to arise between both awake and sleeping patterns,” says Pritchett.

If the physician documents that they performed the EEG while the patient was in a coma or asleep, you’d choose 95822 (... recording in coma or sleep only). “In this procedure, the patient is fully asleep or in a deep coma,” explains Pritchett. The physician performs the EEG in coma/sleep only “to verify if the patient is having active brain wave patterns during abnormalities of sleep, or in the process of brain death,” she says.

Extended EEG Codes Erase Key Elements

If the EEG goes into extended time, coding again gets more opaque. The base codes for 95816-95822 include 20 to 40 minutes of recording time. If the physician records between 41 and 60 minutes of EEG time, you’d report 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes). When the EEG recording time exceeds 60 minutes, opt instead for 95813 (... greater than 1 hour).

When choosing an extended EEG code, the clock is all that matters. Whether your physician is recording awake/drowsy, awake/asleep, asleep/coma, you’ll choose from 95812 and 95813.

Example: Notes indicate that the physician performed an awake/drowsy EEG that lasted 48 minutes. You would report 95812 for the service rather than 95816.

Report E/M-25 With EEG … Sometimes

If the patient reports for a scheduled EEG, then it’s highly unlikely that the physician would perform a significant, separately reportable evaluation and management (E/M) service along with the test.

If, however, the patient reports with a complaint and the physician conducts a full E/M before making the decision to perform an EEG, then a separate E/M might be reportable.

Let’s say an established patient reports to the provider complaining of headaches. The physician performs an E/M that lasts 27 minutes and features low-complexity medical decision-making (MDM). Then, the physician conducts an awake/asleep EEG that lasts 37 minutes.

On the claim, you’d report:

• 95819 for the EEG
• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.) for the E/M service
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to 99213 to show that the E/M service was separately identifiable from the EEG service
• R51 (Headache) appended to 95819 and 99213 to represent the patient’s headache.

Leave Long-Term EEG Codes to the Side

Another potential problem when coding for EEGs is knowing the difference between extended EEG and long-term continuous EEG. Where extended EEGs are typically between 41 and 119 minutes, long-term continuous EEGs last a minimum of two hours — and can last for days.

For long-term continuous EEG, you’ll report 95700 (Electroencephalogram (EEG) continuous recording, with video when performed, setup, patient education, and takedown when performed, administered in person by EEG technologist, minimum of 8 channels) for the setup; then, you’ll choose the appropriate code from 95705 through 95726 (Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of EEG recording, with video (VEEG)) for the actual EEG.