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Billing Medicaid

Patricia Posted Thu 26th of April, 2012 20:14:45 PM

When billing Medicaid and you have questions they keep refering to the global period.
Can someone break this down into terms that I can understand.
Ex: We are a neurology spec. and we bill CPT codes 95951-52, 95953, 95813-59 we think that these should be paid together but we keep getting denied.
Does anyone have any expertise with EEG's and billing Medicaid?
Thanks in advance for any responese :)

SuperCoder Answered Mon 30th of April, 2012 16:00:58 PM

Hi, Patricia, and thanks for the question. Things can get a bit tricky when you start reporting multiple EEGs. Here are my thoughts on the codes you mention.

You should be fine with reporting all 3 EEG codes because of time frames and the types of tests. 95813 represents a routine EEG that lasts more than an hour. The other codes are for more specialized EEGs that run for 24 hours or more.

Code 95813 (the routine EEG) is a Column 2 component of both 95951 and 95953. CCI edits allow you to report the codes together if you include documentation and append modifier -59 to 95813. That might be the case if the physician runs the regular EEG earlier in the day, then decides to do an extended/special EEG for 24 hours or more (because of whatever the initial test results were).

You mentioned appending modifier -52 to 95951. I'm not sure from your info why you need to report reduced services. Code 95951 is based on a 24-hour period. If you record more than 12 hours, you'll need to append -52; if you record more than 12 hours you won't need -52.

I hope that helps,
Leigh DeLozier, CPC
Editor, The Coding Institute

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