Pain Management Coding Alert

You Be the Coder:

Don't Double Dip on EEGs

Question: Notes indicate that the PM physician performed an extended electroencephalogram (EEG). Total monitoring time was 93 minutes. I was going to report 95812 for the first hour and 95813 to account for the remaining 33 minutes. Is this the correct coding?

Minnesota Subscriber

Answer: No, you should not report both of those codes for an EEG with 93 minutes of monitoring. On your claim, report only 95813 (Electroencephalogram (EEG) extended monitoring; greater than 1 hour).

Why? It appears that you might have misread the EEG descriptors. Any time that an EEG lasts more than an hour, you’ll report 95813 — and only 95813. For EEGs lasting 41-60 minutes, report 95812 (… 41-60 minutes) — and only 95812.

In short, 95813 is a standalone code, not an add-on code. You cannot report it along with 95812 to account for monitoring time exceeding 60 minutes.

If you report 95812 and 95813 together, it is not proper coding. A denial will likely head your way.