Do not look at frequency and never overlook a hidden bundle.
Learn how to report the digital analysis and time the physician attendance. This article also review show to identify Correct Coding Initiative (CCI) bundling edits in the EEG codes. Read this expert medical coding article to further learn how to report EEG recording in situations like coma and polysomnography.
Identify Any Digital Analysis
For digital services, after CPT code lookup you turn to code 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]). You, nonetheless, would not universally bill this particular code for digital recording of and/or use of an automated spike and seizure detector on a routine EEG, ambulatory EEG or video-EEG monitoring. You execute CPT code lookup and precisely report 95957 once your physician uses specialized digital services similar to three-dimensional (3D) dipole localization or alike techniques for the EEG recording. Digital analysis is frequently used for presurgical planning as epileptic spike onset must be localized. It would not be suitable to bill 95957 for source localization when the EEG is normal, i.e. no spikes to analyze.
Time the Physician Attendance
When your neurologist uses surface electrodes in the brain to provoke seizures and obtain a mapping, you should use your physician's attendance time, not the recording time, to determine the coding. In this case, after CPT code lookup, you would report 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance) for the first hour of physician attendance.
Following the CPT® 'passing the time requirement, you would append modifier 52 (Reduced services) with the 95961 CPT® code if the neurologist's physical attendance time is 30 minutes or less.
Once you execute CPT code lookup, you report +95962 (… each additional hour of physician attendance [List separately in addition to code for primary procedure]) along with the 95961 CPT code for every additional hour of physician attendance time.
Beware Hidden Bundles
An EEG might be bundled in some medical procedures and these may not indicate the EEG in code descriptors. An instance of such a procedure is the recording of circadian respiration in infants reported with 94772 (Circadian respiratory pattern recording [pediatric pneumogram], 12 to 24 hour continuous recording, infant). CPT® precisely mentions that "separate procedure codes for electromyograms, EEG, ECG, and recordings of respiration are excluded when 94772 is reported." "This parenthetical note is not payer specific, for instance Medicare's CCI edits. It applies to all payers that use CPT® codes to process their claims.
Distinguish Routine Polysomnography
Your neurologist may perform other diagnostic testing during the process of investigating the patient for the seizures, so you should know when to separately report the EEG testing.
Medicare's CCI edits bundle the extended EEG monitoring codes, 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour), as components of the sleep staging investigation codes, 95808 (Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist)-95811 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist).
Learn how to report the digital analysis and time the physician attendance. This article also review show to identify Correct Coding Initiative (CCI) bundling edits in the EEG codes. Read this expert medical coding article to further learn how to report EEG recording in situations like coma and polysomnography.
Identify Any Digital Analysis
For digital services, after CPT code lookup you turn to code 95957 (Digital analysis of electroencephalogram [EEG] [e.g., for epileptic spike analysis]). You, nonetheless, would not universally bill this particular code for digital recording of and/or use of an automated spike and seizure detector on a routine EEG, ambulatory EEG or video-EEG monitoring. You execute CPT code lookup and precisely report 95957 once your physician uses specialized digital services similar to three-dimensional (3D) dipole localization or alike techniques for the EEG recording. Digital analysis is frequently used for presurgical planning as epileptic spike onset must be localized. It would not be suitable to bill 95957 for source localization when the EEG is normal, i.e. no spikes to analyze.
Time the Physician Attendance
When your neurologist uses surface electrodes in the brain to provoke seizures and obtain a mapping, you should use your physician's attendance time, not the recording time, to determine the coding. In this case, after CPT code lookup, you would report 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance) for the first hour of physician attendance.
Following the CPT® 'passing the time requirement, you would append modifier 52 (Reduced services) with the 95961 CPT® code if the neurologist's physical attendance time is 30 minutes or less.
Once you execute CPT code lookup, you report +95962 (… each additional hour of physician attendance [List separately in addition to code for primary procedure]) along with the 95961 CPT code for every additional hour of physician attendance time.
Beware Hidden Bundles
An EEG might be bundled in some medical procedures and these may not indicate the EEG in code descriptors. An instance of such a procedure is the recording of circadian respiration in infants reported with 94772 (Circadian respiratory pattern recording [pediatric pneumogram], 12 to 24 hour continuous recording, infant). CPT® precisely mentions that "separate procedure codes for electromyograms, EEG, ECG, and recordings of respiration are excluded when 94772 is reported." "This parenthetical note is not payer specific, for instance Medicare's CCI edits. It applies to all payers that use CPT® codes to process their claims.
Distinguish Routine Polysomnography
Your neurologist may perform other diagnostic testing during the process of investigating the patient for the seizures, so you should know when to separately report the EEG testing.
Medicare's CCI edits bundle the extended EEG monitoring codes, 95812 (Electroencephalogram [EEG] extended monitoring; 41-60 minutes) and 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour), as components of the sleep staging investigation codes, 95808 (Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist)-95811 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist).
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