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Video EEG in hospital setting

Arlene Posted Wed 27th of March, 2013 19:34:15 PM

Can you bill a 95956 and 95951 together?

SuperCoder Answered Mon 01st of April, 2013 21:10:55 PM

Yes, no issues with current CCI Edits.

Arlene Posted Thu 04th of April, 2013 15:22:02 PM

we also do a spike analysis in addition to the test, 95957, can we bill that as well?

SuperCoder Answered Fri 05th of April, 2013 11:54:55 AM

There is no CCI bundling issue between these 3 codes. However please read through the CPT Assistant Nov. 2010 article regarding the same. This contains multiple scenarios in EEG coding:

Coding Brief: EEG Epileptic Spike Reporting

An electroencephalography (EEG) is an important test used for diagnosing epilepsy. Electrodes are attached to the scalp and record the normal or abnormal electrical activity of the brain. Certain abnormal patterns include spikes and sharp waves and may indicate seizure activity or epilepsy. This coding brief addresses the frequently asked questions posed when EEG is performed to test for epilepsy.

Question: When can code 95957 be billed, assuming that code 95951 has also been performed and billed for the same patient (ie, what is the medical necessity for code 95957 when code 95951 has been performed)?

Answer: Code 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 (eg, for presurgical localization), each 24 hours, includes digital EEG recording, spike detection, and seizure detection. Code 95957, Digital analysis of electroencephalogram (EEG) (eg, for epileptic spike analysis), should not be used for digital EEG recording, spike detection, or seizure detection.

Question: What is the extra time and effort that would accompany code 95957 both by the technician and the physician, in addition to that encompassed by code 95951?

Answer: Code 95951 does not include three-dimensional spike source analysis. Code 95957 can be used for source analysis for the epileptic spikes found in an EEG recording, such as a 24-hour video-EEG recording reported with code 95951. In that case, code 95957 is one unit of service and is not separately coded for each spike analyzed.

Question: Is it appropriate to report code 95957 routinely for every patient for whom an epileptic spike is reflected on the 24-hour EEG encompassed by code 95951?

Answer: The procedure described by code 95957 is medically necessary when the spike onset must be localized for presurgical planning. Many patients receive video-EEG monitoring for other reasons such as differential diagnosis, and in those cases, code 95957 is not likely to be medically necessary. Other patients receive video-EEG monitoring for presurgical planning, and for some of those patients the source analysis with code 95957 is medically necessary.

Question: If there are multiple epileptic spikes in a 24-hour EEG recording, is it appropriate to report code 95957 for an analysis of each spike, or is code 95957 a global code billed only once for the entire 24-hour EEG?

Answer: Code 95957 is reported for the entire 24 hours, regardless of the number of spikes analyzed. It is not appropriate to report code 95957 for source localization when there are no spikes to analyze (eg, when the video-EEG monitoring is normal).

Question: Can code 95957 be billed if EEG monitoring is normal?

Answer: It is not appropriate to report code 95957 for source localization when there are no spikes to analyze (eg, when the video-EEG monitoring is normal). However, code 95957 is sometimes used for reasons other than threedimensional spike source analysis. Thus, the answer to this question depends on the particular reason specified. To report code 95957 for reasons other than three-dimensional spike source analysis, the patient's record must clearly reflect why the digital analysis was needed.

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