Peter Posted Wed 28th of March, 2012 14:25:43 PM
DOES ANYONE KNOW WHY MOST INSURANCE COMPANIES ARE LISTING 95957 AS A NONCOVERED CODE. THIS WAS NOT THE CASE LAST YEAR. WHAT HAS CHANGED?
SuperCoder Answered Wed 28th of March, 2012 15:45:31 PM
Code 95957 should not be used simply when the EEG was recorded digitally. There is no additional charge for turning on an automated spike and seizure detector on a routine EEG, ambulatory EEG, or video-EEG monitoring. Nor is there an additional code for performing EEG on a digital machine instead of an older generation analog machine. Some features of digital EEG make it easier and quicker to read, and other features slow it down by providing new optional tricks and tools. Overall, it is about the same amount of work as an analog EEG.
Code 95957 is used when substantial additional digital analysis was medically necessary and was performed, such as 3D dipole localization. In general, this would entail an extra hour's work by the technician to process the data from the digital EEG, and an extra 20-30 minutes of physician time to review the technician's work and review the data produced. Most practitioners would not have the opportunity to do this advanced procedure. It would be more commonly used at specialty centers, e.g. epilepsy surgery programs. Note that the codes for "monitoring for identification and lateralization of cerebral seizure focus" already include epileptic spike analysis.
First, make sure that 95957 is the appropriate code to report.You must provide medical necessity to report 95957, and the physician must supply evidence to demonstrate that the results will affect patient management directly.