Awake Only EEG?

akoschoff

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How would you code this EEG? It seems like it would be awake only. But others are saying lethargic = drowsy.

Indications: Diagnostic EEG performed on a 69 y.o. male with mental status changes and left temporal ICH.

Technical Description: This study was performed using Nihon Kohden digital electroencephalographic recording equipment. International 10-20 electrode placement was used. Multiple montages are used for interpretation. The record was obtained with the patient in a lethargic state. The record is of excellent technical quality purposes of interpretation. Video monitoring was utilized.

Activation Procedures: photo stimulation

EEG Description
Awake: Alpha Activity: The waking state record contains a poorly-defined asymmetric alpha rhythm of moderate amplitude with a dominant frequency of 5-6 Hz. There is suppression of the left temporal occipital regions.
Sleep: drowsiness and sleep are not identified.

Result of Activation Procedures:
Hyperventilation: not performed.
Photo Stimulation: Stimulation at 1-21 Hz does not elicit a driving response.

Summary
This is a severely abnormal EEG due to the presence of suppression of the left hemisphere primarily in the left temporal occipital regions consistent with the reported intracranial hemorrhage. No seizures are identified.

Thank you in advance.
 

mhstrauss

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How would you code this EEG? It seems like it would be awake only. But others are saying lethargic = drowsy.

Indications: Diagnostic EEG performed on a 69 y.o. male with mental status changes and left temporal ICH.

Technical Description: This study was performed using Nihon Kohden digital electroencephalographic recording equipment. International 10-20 electrode placement was used. Multiple montages are used for interpretation. The record was obtained with the patient in a lethargic state. The record is of excellent technical quality purposes of interpretation. Video monitoring was utilized.

Activation Procedures: photo stimulation

EEG Description
Awake: Alpha Activity: The waking state record contains a poorly-defined asymmetric alpha rhythm of moderate amplitude with a dominant frequency of 5-6 Hz. There is suppression of the left temporal occipital regions.
Sleep: drowsiness and sleep are not identified.

Result of Activation Procedures:
Hyperventilation: not performed.
Photo Stimulation: Stimulation at 1-21 Hz does not elicit a driving response.

Summary
This is a severely abnormal EEG due to the presence of suppression of the left hemisphere primarily in the left temporal occipital regions consistent with the reported intracranial hemorrhage. No seizures are identified.

Thank you in advance.


This is from the AAN:

"Q: What is the difference between 95816 (EEG recording including awake and drowsy) and code 95819 (EEG recording including awake and asleep)?

A: The answer is that to use 95819 the patient must have fallen asleep and if not 95816 should be used. However, the line between drowsy and asleep can often be difficult to determine and it is permissible to use 95819 if a sleep study was intended, but, despite the best efforts of the technician, sleep was not obtained."


HTH!
 
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