We make it easy to find the online medical coding solution with just the features you need! |Learn More >>

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.

Other Articles in this issue of

Pain Management Coding Alert

View All