Wiki EEG for awake and alert patient

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jd27

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Hi,

I've been coding IRadiology for a few years but am currently new to Neurology, and I had a question concerning coding for EEG exams. I have several reports here where the physician has indicated on the report that the patient was "awake and alert" during the procedure. Since the wording in the CPT states awake and drowsy (95816) or "awake and asleep" (95819) where does awake and alert fall??

Thanks,
 
I know this has been a long time ago, but did you ever get a resolution to this? I am having a rash of denials because Dr only did awake part of EEG and insurance is denying because they are saying 95816 states awake and drowsy. I am desperate for help!
 
Did you check CPT Assistant or any references from AAN?
Can a 52 modifier be used possibly?

"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."

If you follow the same lines as this link and statement above, if the intent was awake and drowsy but the patient never got drowsy could you still code 95816?
It is best to start with CPT Assistant to check first.
 
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