Wiki Routine EEG and Continuous EEG/VEEG performed on the same day.

[lescrusenberry@gmail.com]

Per AMA/CPT guidelines for Routine EEG (95812-95822), "Do not report in conjunction with Long-term continuous EEG services (95700-95726)".

I am having to review Neurologist inpatient visits when routine EEG and continuous EEG are performed on a patient at the same encounter date.

Question:

1. Has anyone come across performing coding reviews and providing education to providers who claim to perform these services on the same patient at the same encounter date?
2. Is there an exception to this rule based on medical necessity?
3. Would a distinct modifier 59 be appropriate to apply if documentation supports services performed?
4. If allowed, in what scenario would these two services support medical necessity to be performed on the same day?
5. Are dictated Letters of Medical Necessity requested from the provider when claims are denied?