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Pain Management Coding Alert

Reader Question:
Use Modifier 52 with Incomplete EEG

Question: One of our physicians performed an electroencephalogram (EEG) video monitoring for 16 hours and interpreted the results. I was going to report 95813, but it seems insufficient for the work. What code should I report?

Tennessee Subscriber

Answer: This is a tough question. You probably don't want to report 95813 (Electroencephalogram [EEG] extended monitoring; greater than 1 hour) because it doesn't represent video recording and interpretation.

Potential option: You might want to 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) with modifier 52 (Reduced services) appended.

If you were reporting 95951-52, you'd have to include a detailed description of why the physician had to reduce the services. Even with that documentation, however, this coding option might not fly with payers.

Do this: Before resubmitting the claim, you're probably best off contacting the payer, explaining the situation, and seeing how it would like you to code the EEG.

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