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Outpatient Facility Coding Alert

Reader's Question:

Go Ahead and Bill EEG With Hospital Visit

Question: Medicare denied our bill for an EEG when our physician read one in addition to a hospital visit. Can you please provide guidance for the best coding approach?

Florida Subscriber

Answer: Yes, you can report an EEG reading with a hospital visit.

The NCCI currently has no bundling edits between the electroencephalogram codes and the initial or subsequent hospital care E/M codes. Medicare, however, does cover the diagnostic testing services provided in a facility setting, such as a hospital POS (Place of service) 21, as separate components.

Note that the technical component of diagnostic testing is included in the facility’s DRG payment. Your physician must bill the EEG reading with modifier 26 (Professional component)  to be paid for the professional component only. You will typically face a denial with Medicare for a diagnostic testing billed globally, i.e., when you append no modifier for a service performed in a facility.