Billing Medicaid

pajohnson

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Kokomo, Indiana
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When billing Medicaid and you have questions they keep refering to the global period.
Can someone break this down into terms that I can understand.
Ex: We are a neurology spec. and we bill CPT codes 95951-52, 95953, 95813-59 we think that these should be paid together but we keep getting denied.
Does anyone have any expertise with EEG's and billing Medicaid?
Thanks in advance for any responese :)
 
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4,466
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Milwaukee WI
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Mutually exclusive

This is NOT my area of expertise, but ...

I do not think you can use all these codes for the SAME DOS. Two of them are for a 24-hour period (95951 and 95953), while the third is for an EEG of greater than one hour.

The only way I can see that you would use them on the same claim is if you had multiple dates of service, all being submitted on one claim.

I do not understand why you would receive a "global" denial, unless there was some neurosurgery involved and MediCare is considering the monitoring to be global to that surgery.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

KellRey

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I also work in a neurology office and you definitely can not bill all of these CPT codes for the same EEG on the same DOS because they are for different kinds of EEGs.

We use CPT 95951 for our patients that are in the Epilepsy Monitoring Unit where they are being videotaped while they are also hooked up to the EEG leads. This code is billed once for every 24 hours.

CPT code 95953 is for an ambulatory EEG where the patient is hooked up to a portable machine at the office and then wears it at home for 1-3 days and then returns to our office to have it removed and analyzed. This is also billed once for every 24 hours.

CPT code 95813 is for a regular routine EEG in the office that is longer than an hour.

What kind of EEG is the patient actually having?
 
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