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Neurology & Pain Management Coding Alert

Reader Question:

Remember All Elements When Choosing EEG Code

Question: The physician performed electroencephalography (EEG) video monitoring on a patient for three hours and interpreted the results. I reported 95813 for this service but our payer denied it, explaining that the documentation does not support the code I reported. Can you please help me understand why this claim was denied?

Washington, DC Subscriber

Answer: You would not be correct to submit code 95813 (Electroencephalogram (EEG) extended monitoring; greater than 1 hour) because it doesn’t represent video recording and interpretation. Instead, assuming the video EEG was performed for localization of a cerebral seizure focus, you should report 95951 (Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation (e.g., for presurgical localization), each 24 hours) and append modifier 52 (Reduced services).

Don’t miss: The CPT® section guidelines direct you to append modifier 52 with code 95951 when recording 12 hours or less.