Billing and Coding

Coding FAQs

Electroencephalography (EEG)

 

Q: When should the extended monitoring EEG CPT codes 95812 and 95813 be used?
A: Routine length of monitoring is now defined as lasting 20 to 40 minutes. The extended monitoring codes are to be used for monitoring times greater than 40 minutes. Code 95812 is defined as covering 41-60 min of monitoring and code 95813 is defined as covering any monitoring that is greater than one hour. Codes 95812 and 95813 can be used in place of 95816, 95819 or 95822 but are not to be billed together with them.

 

Q: What is the minimum number of channels or electrodes to be used in order to report codes 95812, 95813, 95955, and 95822?

A: One has to meet the minimum technical standards for an EEG test, not only with a minimum of 20 minutes of monitoring, but with a minimum of eight channels and other rules as set forth by national organizations such as the American Clinical Neurophysiology Society.

 

Q: What is the purpose of video monitoring equipment on some of the new EEGs?
A: The purpose is to record what the patient was doing during the routine EEG for clinical correlation purposes. Is there an extra code to bill for an EEG with video in this situation? There is no extra fee or code for using the video in this context. It's still the same code as if no video.

 

Q: What do I do if the monitoring is less than 24 hours (i.e. 8 hours, 10 hours etc.)?
A: In the opinion of the American Academy of Neurology and the American Clinical Neurophysiology Society, more than half of the 24 hours of monitoring is adequate to use these codes. If the recording time is less than 12 hours, one should bill the appropriate monitoring code with modifier 52 to indicate the service was reduced in some way (as described in the CPT book) and to indicate the actual number of hours that the study was performed

 

Q: What is the appropriate CPT code for ambulatory EEG recordings?
A: CPT code 95950 is commonly used for ambulatory 24 hour EEG recording.

 

Q: What is the difference between CPT code 95953 and 95956?
A: CPT code 95953 is commonly used for simple take home digitally recorded ambulatory EEGs. CPT code 95956 is a study which is performed in a facility setting with staff present the entire time the study is performed.

 

Q: When should I not use Code 95957? When do I use Code 95957?
A: 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.

Evaluation / Management (E/M)

 

Q: When is time a factor in determining the coding level of the usual evaluation and management services (new and established patient office visits, consultations and hospital follow-ups)?
A: When counseling and/or coordination of care dominates (more than 50 percent) of the physician/patient and/or family encounter, then time, rather than elements of history, physical examination and medical decision-making, is the key controlling factor in the level of evaluation and management service determination. The definition of each evaluation and management code lists its typical time. The total length of time of the encounter should be documented and the medical record should describe the counseling and/or activities to coordinate care. The definition of "time" differs in outpatient and inpatient settings: face-to-face time: office and other outpatient visits and office consultations, unit/floor time: hospital observation services, inpatient hospital care, initial and follow-up hospital consultations, nursing facility.

Q: How do I code for extended evaluation and management services where counseling and coordination does not comprise a majority of the visit?
A: In this case the use of prolonged services codes would be appropriate. These codes involve direct patient contact that is beyond the typical time for an evaluation and management service, and can be reported in addition to the evaluation and management code. You must document the reason for the prolonged service in the patient record to account for the use of these codes. There are different sets of codes for inpatient and outpatient settings. Each set includes a code for the first hour of prolonged services and another code for each additional 30 minutes.

Q: In what other situation would time be a consideration in coding for evaluation and management?
A: The critical care codes are another instance in which coding is based on the amount of time of service. Critical care codes account for the time spent at the bedside or on the unit delivering care to a critically ill or injured patient. They can be reported in addition to an evaluation and management code. One code is for critical care during the first 30-74 minutes; another code is for each additional 30 minutes of critical care. The time does not need to be continuous and should be reported based on the total hours of care delivered in a 24-hour period.

Nerve Conduction Studies

 

Q: Which code is used for mixed nerve conduction studies?
A: Each type of study (motor with F-wave, motor without F-wave, sensory, h-reflex) performed on each nerve segment, as listed in "Appendix J" of the CPT code book, counts as one study. Add the number of studies performed to get to the appropriate code (95907-95913).


Q: If I perform a sensory study and a motor study for the same nerve, does that count as one study or two studies?
A: It counts as two.


Q: If I perform a median motor + sensory and ulnar motor + sensory is that four units (95908) or is that two units (95907) because I only studied two nerves?
A: This scenario counts as four studies, and you would report one unit of 95908.

Q: Do we count bilateral H reflex studies separately?
A: Yes, this would count as two studies.

Q: Is an H-reflex study, motor study, and sensory study of the same nerve regarded as three tests?
A: Yes, the appropriate code would be 95908 (3-4 studies).

Q: Is performing NCS on one nerve considered one study?
A: Not necessarily. If you perform a motor and sensory study on that one nerve, it would be counted as two studies.

Q: If we bill 95909, do I report one unit or the amount of studies we performed (i.e. five)?
A: Since the number of studies performed is inherent in the coding structure, the appropriate way to report this service is one unit of 95909 (5-6 NCS studies).

Q: If a patient is scheduled for testing with a diagnosis of carpal tunnel syndrome (CTS), but when the physician examines the patient, the patient complains of lower limb pain and is therefore also tested for peripheral neuropathy, is this bundled as one NCS or is the billed separate because different extremities are tested for different diagnoses?
A: List all of the diagnoses (ICD-10 codes) on the claim form, listing the most complicated first, but lump all of the studies together, as was previously done. Ultimately, one NCS code (95907-95913) will be used.

Q: Where can we get the full "Appendix J" for 2018?
A: Access Appendix J. It can also be found in the 2018 CPT book. You can also refer to the Expanded Appendix J for examples of a reasonable number of studies performed per neurology indication.

Transitional Care Management (TCM) Services

 

Q: Are the transitional care codes billed in addition to the face-to-face visit?
A: CMS requires a face-to-face visit, initial patient contact, and medication reconciliation within specified time frames. The first face-to-face visit is part of the TCM and not separately reported. Additional face-to-face visits within the 30-day period may be reported separately.

Q: When do I submit the TCM codes? Do I submit it the day when you talk to the patient/caregiver, or on the 7th or 14th day when I see the patient for the face-to-face encounter?
A: The date of service for TCM codes is not the date of the face-to-face visit. The time is still running until day 29 for TCM services. The TCM charges should be submitted 30 days following discharge.

Q: If you submit the 99495 code prior to the 7th of 14th day, what happens if the patient does not show up for follow-up?
A: Do not submit the code until the follow up visit physically occurs. Medicare will deny the charges if they are submitted sooner than 30 days from the date of discharge. If you are unable to have a face-to-face follow-up within 7 to 14 days from discharge you would be unable to bill either of the TCM codes.

Q: What documentation is needed to report a transitional care code?
A: Within two business days of discharge, an interactive contact with the patient or caregiver must take place. This contact can be face-to-face or by telephone or electronic means. A face-to-face visit must take place within 7 or 14 calendar days following discharge depending on the complexity of the patient and code reported Medication reconciliation and management must take place no later than the date of the first face-to-face visit following discharge.