You should report a video electro-encephalograph (EEG), also known as video EEG monitoring (VEM), using 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).
VEM monitors a patient's behavior and his brain electrical activity, using dedicated equipment that simultaneously records EEG, video and sound. This is useful, for instance, to distinguish epileptic seizures from conditions that may mimic epileptic seizures, to determine the type or types of seizures that the patient has, or to localize the portion of the brain in which the seizures are arising.
Most Medicare carriers cover ambulatory or 24-hour (EEG) monitoring (including 95950-95951, 95953 and 95956) "for patients in whom a seizure diathesis is suspected but not defined by history, physical or resting EEG," according to a typical Medicare carrier review policy. Examples of covered diagnoses include:
013.xx - Tuberculous/tuberculoma
036.0-036.1 - Meningococcal meningitis or encephalitis
191.0-192.x - Malignant neoplasm, various
225.0-225.2 - Benign neoplasm, various
292.81-292.89 - Other specified drug-induced mental disorders
293.0-293.1 - Delirium, acute or subacute
295.20-295.24 - Schizophrenic disorders
332.0-332.1 - Parkinson's disease
337.0-337.9 - Disorders of the autonomic nervous system
340 - Multiple sclerosis
345.90-345.91 - Epilepsy, unspecified
346.xx - Migraine
350.1-350.9 - Trigeminal nerve disorders
854.xx - Intracranial injury.
Individual carriers may specify different guidelines, and you should contact your individual payer for a complete list of allowable ICD-9 codes.
In addition, many providers bundle video EEG to sleep studies (95805-95811). Therefore, you should not report 95951 separately when billing for sleep studies.
The appropriate code for video electro-encephalography (EEG) of 15-24 hours is 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), according to coding conventions supported by the American Clinical Neurophysiology Society and many insurers. You do not need to append modifier -52 (Reduced services) for fewer than 15 hours of monitoring, although you should append the modifier for 15 hours or less. Not all payers follow this policy, however, so you may wish to contact the individual insurer prior to billing.
If the video EEG extends beyond 24 hours, you may report multiple units of 95951. And remember to append modifier -26 (Professional component) to clarify that the neurologist is providing only the interpretation and report, and does not incur the cost of running/maintaining the necessary equipment.