Ambulatory EEG's 95953

mquilty

New
Messages
3
Location
Holliston, Massachusetts
Best answers
0
Hi All,
Was wondering if someone has some good experience with coding reg's for Ambulatory EEG's. Found some good info. so far, but have some follow up ?'s.

If using 95953 - does the provider need to add in their note that they did the awake/sleep EEG prior?
With same code above - for the units (for example 47 hours - can we enter the 2 units or does it have to be exact? Or, if 64 hours can we add the 3 units or do we code each day? For example: "Continuous EEG monitoring began on 11/11/16 at 15:37 hours and ended on 11/13/16 at 10:21 hours = to 64 hours recording time. Would we code the 95953 each of 11/11, 11/12 and 11/13 and units based on hours each day?

Lastly, I hope. If they do any recording then should we just code 95951 rather than the 95953?

Hope this all makes sense?

TIA,
 
Messages
5
Location
Lexington, KY
Best answers
0
Ambulatory EEGs

Tia,

I code ambulatory EEGs. I do mine by line item date. I used 95951 because we use video. If a provider orders a 72 hour video ambulatory
EEG and the duration was 64 hours. Then I would charge 01/01/17, 01/02/17, 01/03/17. If the duration was 59 hours and 10 minutes, the I would charge as follows. Keep in mind my company is the technical component.

01/01/2017 95951-TC

01/02/2017 95951-TC

01/03/2017 95951-TC-52

The modifer 52 would go on the date of service that is less than 12 hours.

Does this make sense?
 

mquilty

New
Messages
3
Location
Holliston, Massachusetts
Best answers
0
Ambulatory EEG's

Thank you so much Sue, is it? This is VERY helpful.
I am newer to this area, so I may have other questions in the future...if that is OK.

Really appreciate your taking the time to outline so carefully.
Happy New Year!
 
Messages
1
Best answers
0
Hook-up for EEG

Hi all...

Is there a way for the provider to charge for the hook-up of the EEG and if so, what would we report?

And if I understand correctly you would bill 95951 for an unattended EEG only because it has the video, correct? I am reading different scenarios elsewhere where some say bill 95953 however 95953 does not include video.

Thank you,
Christy
 

Launie75

Contributor
Messages
12
Best answers
0
Ambulatory EEG's 95953 vs 95951

Yes if someone can provider greater clarification.. I too am finding mixed reviews on 95953 vs 95951... 95951 is the only one to specifically state video... but Aetna policy considers 95953 as home video... We keep getting denials from UHC when using 95951 once we submit our records. It is all the same technical set up by UHC approves half and then state on other half it is not the right code even though the technical component is the SAME...

so is the difference is 95953 is home w/wo video unattended computerized portable

and

would these state that they are not portable and remain in office?
95951 is consistent clinical attendance w/video? CPT doesn't show anything about this code being attended? States video & eeg 24hr cable/radio

95956 makes NO mention of video but says attended by nurse or tech cable/radio

It seems like they all contradict each other by carrier making it difficult to really know which to properly bill.. based on what carrier say... AETNA says they state vs what AMA/CPT states, etc.


http://www.aetna.com/cpb/medical/data/400_499/0425.html
Aetna considers the combined use of ambulatory EEG and home-video recording an equally acceptable medically necessary alternative to ambulatory EEG alone. Note: Ambulatory EEG with home video recording is correctly coded as ambulatory EEG (CPT code 95953); the video EEG (95951) and attended EEG (95956) CPT codes require contemporaneous in-person attended monitoring (AMA, 2014).
 

tina1999

New
Messages
2
Location
Las Vegas, NV
Best answers
0
95951 vs 95953

Hey everyone

Not sure if you guys still had questions on this subject or not but I came across it and thought I'd put my two cents in :)
I've worked Neurology in the past for about 5 years and now working with Optum as a auditor and this question comes up quite often. If your a Neurology provider is who hooking up the equipment to a patient and sending them home then this is NOT an attended ambulatory EEG and the correct code would be 95953.

95951 should only be used when a technologist is on site who can make interpretations throughout the procedure for the full 24, 48 or 72 hours. I've seen a ton of providers offices billing 95951 for the above scenario to only have to pay back money so be careful when selecting these codes. The American Neurology Academy has a great article about this if you search their site. Remember even though some commercial payers are still allowing 95951 and might not have caught on yet, they will and your opening yourself up for an audit.

We would only bill 95951-26 video or non video 95956-26 when these are done in the hospital (as 24 hour monitoring is going on by staff) but if your in an office setting and using pos 11, the correct ambulatory video EEG CPT code is 95953.

Hope this helps anyone, when in doubt remember to always apply the CPT guidelines to your code selection. CPT clearly states 95951 and 95956 are used for recordings in which interpretation can be made throughout the recording time, with interventions to alter or end the recording or patient care as needed. Do not let your doctor tell you 95951 is the correct code and fall in to this audit and do not let cadwell tell you how to bill these services. Oh! and most importantly do not forget to mark your start and stop times for each dos. We are seeing providers not documenting the time therefore not being paid.

Christina, CPC
 
Last edited:

TTown

Guru
Messages
203
Location
Cary, NC
Best answers
0
Hey everyone

Not sure if you guys still had questions on this subject or not but I came across it and thought I'd put my two cents in :)
I've worked Neurology in the past for about 5 years and now working with Optum as a auditor and this question comes up quite often. If your a Neurology provider is who hooking up the equipment to a patient and sending them home then this is NOT an attended ambulatory EEG and the correct code would be 95953.

95951 should only be used when a technologist is on site who can make interpretations throughout the procedure for the full 24, 48 or 72 hours. I've seen a ton of providers offices billing 95951 for the above scenario to only have to pay back money so be careful when selecting these codes. The American Neurology Academy has a great article about this if you search their site. Remember even though some commercial payers are still allowing 95951 and might not have caught on yet, they will and your opening yourself up for an audit.

We would only bill 95951-26 video or non video 95956-26 when these are done in the hospital (as 24 hour monitoring is going on by staff) but if your in an office setting and using pos 11, the correct ambulatory video EEG CPT code is 95953.

Hope this helps anyone, when in doubt remember to always apply the CPT guidelines to your code selection. CPT clearly states 95951 and 95956 are used for recordings in which interpretation can be made throughout the recording time, with interventions to alter or end the recording or patient care as needed. Do not let your doctor tell you 95951 is the correct code and fall in to this audit and do not let cadwell tell you how to bill these services. Oh! and most importantly do not forget to mark your start and stop times for each dos. We are seeing providers not documenting the time therefore not being paid.

Christina, CPC

Hi Christina,

I have a follow-up question if you don't mind as I am researching this for the pediatric neurology group that I work with. I've found the CPT Assistant information in 3M; however one of the groups that we utilize the equipment from actually has a tech that monitors the patient by webcam via the parent's smartphone/tablet/computer and in the event of anything happening would call our on-call physician who would in turn contact the patient's parent if needed - in this instance would I still use the 95953? The other supplier has blatantly stated that they don't use techs to monitor but that we must bill 95951-26 when we use their services which I believe is wrong and they asked for information to prove them wrong so I sent the CPT Assistant information.

Thank you
 

lcooper21

New
Messages
2
Best answers
0
95951 vs. 95953

I have a similar question to what @twtcpc has posted. We contract with an outside company to provide 24/7 real-time monitoring of patients for in home EEGs. If there are any interruptions or issues with the EEG, that need to be adjusted, the technologist and/or physician will contact the patient via phone, web or in person if needed. They will correct the issues as if the patient was in the office and the technologist/physician were in the room. Can we bill the interpretation using the 95951? 95951 seems to fit with what Neurotech is providing.

Below is from the Neurotech website.

In addition, we require all of our scanning and monitoring technologists to be credentialed by the American Board of Registered Electroencephalographic Technologists (ABRET). Our technologists are experienced working with children and adults of all ages as well as patients with mental and physical disabilities. Our technologists remotely monitor patients 24 hours/day to ensure quality control and are available to patients by phone throughout the duration of the EEG study.

Technologists continually monitor the impedance level of each patient’s electrode connections to the head. In addition, all video recordings are monitored by a technologist to verify the patient is on camera. If a problem is identified, our monitoring technologists will correct it by remotely accessing the patient’s equipment, or, if necessary, dispatch an on-call technologist to the patient’s home to fix the problem. As a result, Neurotech’s EEG test results are uncompromised, virtually eliminating the need for re-testing.


Thank you for the help!
 
Last edited:

dgarcia2

New
Messages
2
Location
Wyoming, MI
Best answers
0
95951 vs. 95953

I have a similar question to what @twtcpc has posted. We contract with an outside company to provide 24/7 real-time monitoring of patients for in home EEGs. If there are any interruptions or issues with the EEG, that need to be adjusted, the technologist and/or physician will contact the patient via phone, web or in person if needed. They will correct the issues as if the patient was in the office and the technologist/physician were in the room. Can we bill the interpretation using the 95951? 95951 seems to fit with what Neurotech is providing.

Below is from the Neurotech website.

In addition, we require all of our scanning and monitoring technologists to be credentialed by the American Board of Registered Electroencephalographic Technologists (ABRET). Our technologists are experienced working with children and adults of all ages as well as patients with mental and physical disabilities. Our technologists remotely monitor patients 24 hours/day to ensure quality control and are available to patients by phone throughout the duration of the EEG study.

Technologists continually monitor the impedance level of each patient’s electrode connections to the head. In addition, all video recordings are monitored by a technologist to verify the patient is on camera. If a problem is identified, our monitoring technologists will correct it by remotely accessing the patient’s equipment, or, if necessary, dispatch an on-call technologist to the patient’s home to fix the problem. As a result, Neurotech’s EEG test results are uncompromised, virtually eliminating the need for re-testing.


Thank you for the help!
I know you posted this a while ago but was wondering if you found an answer on appropriate billing for this situation?

Thank you!
 

lcooper21

New
Messages
2
Best answers
0
Yes we did. However, the codes have been revised as of October 2019 so they now describe our situation and allow for more clarity regarding how to bill in this situation. The CPT book now defines our situation as "continuous real-time monitoring (may be provided remotely). The codes are now reported using 95700-95726, depending on the time and the type of monitoring.
 
Top