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Routine EEG Billing

Luz Posted Thu 19th of July, 2018 08:41:03 AM
The physician placed a report for the routine EEG, however it was essentially unreadable due to patient behavior throughout the recording. What is the policy here in terms of being able to bill for the read. Your help is appreciated.
SuperCoder Answered Fri 20th of July, 2018 06:38:51 AM

Hi Luz,

 

Thank you for your question.

As per CMS there are some undermentioned non-covered indications to bill EEG services.

  • Study of neonates or unattended
  • non-cooperative patients
  • Localization of seizure focus or foci when the seizure symptoms and/or other EEG recordings indicate the presence of bilateral foci or rapid generalization.

As per the above statement (it was essentially unreadable due to patient behaviour throughout the recording) it seems patient was non-cooperative during the procedure and recording obtained were unreadable. Hence, this service as per CMS direction would not be reportable. It is advised to check with your payer if they have any specific guidelines for such scenario.

Please find undermentioned CMS link for more information.

>https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33447&ver=33&SearchType=Advanced&CoverageSelection=Local&ArticleType=SAD|Ed&PolicyType=Both&s=All&CptHcpcsCode=95812&kq=true&bc=IAAAACAAAAAA&

Luz Posted Fri 20th of July, 2018 08:30:42 AM
Thank you! I found LCD 33447 but does not mention indications regarding non-cooperative patients.
SuperCoder Answered Mon 23rd of July, 2018 01:06:29 AM

Thank you for your response!

 

 

Please find this information in LCD policy L33447 under heading LIMITATIONS (NON-COVERED INDICATIONS). The undermentioned information is mentioned in the policy.

 

  • Study of neonates or unattended, non-cooperative patients;
  • Localization of seizure focus or foci when the seizure symptoms and/or other EEG recordings indicate the presence of bilateral foci or rapid generalization.

Hope this helps!

Luz Posted Mon 23rd of July, 2018 09:24:49 AM
Found it, I missed it. Thank you so much; it does help-much appreciated
SuperCoder Answered Tue 24th of July, 2018 00:49:08 AM

Thank you, happy to help.

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