CPT 95951 Video EEG - Neurology - not the right code
I have been researching extensively. Ambulatory video EEG testing, at home, is not reported with 95951. This is intended more for a facility setting. My evidence, so to speak, comes from:
1. a personal conversation with a physician who sits on the RUC committee and said it is "never appropriate to use it for in home testing". My apologies, I do not have his permission to release his name. This conversation took place in mid to late June, 2017. We had an extensive conversation about the code's intent, how the RVUs were set up... you name it, he had an answer.
2. WPS Medicare, I have it in writing, says this is not the code to use (received the response 08/10/17). Here is a copy of our questions we submitted, and their answers:
Thank you for contacting Wisconsin Physicians Service (WPS) Government Health Administrators (GHA) for assistance regarding Medicare’s definition of “attended” as it pertains to CPT codes 95951 and 95953. Your inquiry also asks for billing guidance concerning these codes.
I consulted with our Medical Policy staff concerning your request. The response below is reflective of the response I received.
In this instance, the term “attended” or “attendance” means physically being there. Regarding your specific billing questions, I have restated your questions to correspond with the responses.
Question 1:
If a testing facility is doing 24-hour monitoring with certified staff of the EEGs, with video recording, in the patient’s HOME, then is code 95951 appropriate?
Response 1:
No. The service requires attendance. Live feeds or telemetry is not the same as “attendance.”
Question 2:
If a testing facility is doing less than 24-hour monitoring with certified staff of the EEGs, with video recording, in the patient’s home, then is code 95951 appropriate?
Response 2:
No. The CPT code is used per 24 hours and attendance would not have been met.
Question 3:
If the patient has the camera set up in their living room, and a technician is monitoring via “live feed”, does this qualify for “attendance”, making 95951 the correct code? (of course, assuming all other qualifiers were met).
Response 3:
No. That does not qualify for payment consideration.
If you require coding assistance, we suggest you seek professional coding assistance, as the WPS Staff are not professional coders. We have an article on website that explains this in more detail and provides coding resources you may find beneficial. The article is available on our website at:
https://www.wpsgha.com/wps/portal/mac/site/claims/faqs
For your convenience, I am including verbiage from the question/answer.
Question:
Can Medicare help me determine the appropriate codes to use on my claims?
Answer:
Per regulations in the IOM Publication 100-09, Chapter 6, Section 30.1.1, Medicare contractors are prohibited from providing coding advice to providers. Providers are responsible for determining the correct diagnostic and procedural coding for the services they furnish to Medicare beneficiaries. Providers with inquiries about interpretation of procedural and diagnostic coding, should refer to the resources provided in the IOM noted above.
If you need additional assistance from our office regarding this matter, please include the reference number above in any correspondence. If you need immediate assistance, you may reach our Provider Contact Center by calling 866-518-3285 and selecting “General Inquiries.”
