Healthcare Fraud Shield’s Latest Article: Ambulatory EEGs

11 Dec
An electroencephalogram (EEG) is a test used to evaluate the electrical activity of the brain.   In this noninvasive procedure, electrodes are applied to the head and the test tracks and records brain wave patterns.   This article will examine special EEG testing procedures known as ambulatory EEGs (AEEG).  AEEGs are most commonly ordered to diagnose, localize or categorize a seizure disorder.  This type of EEG allows the patient to move around (hence the nickname ambulatory) and allows for an extended recording time over a number of hours or days[i].

 

The following four (4) CPT codes fall under the category of ambulatory EEG:

 

  • CPT code 95950 – Monitoring for identification and lateralization of cerebral seizure focus; electroencephalographic (e.g., 8 channel EEG) recording and interpretation, each 24 hours
  • CPT 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 (e.g., for presurgical localization), each 24 hours
  • CPT code 95953 – Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended
  • CPT code 95956 – Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technologist or nurse
When choosing the appropriate AEEG code for the service provided, we notice that one of the codes mentions the use of 8 channels (waveforms), while the other 3 codes require the use of 16 or more channels.  Additionally, CPT code 95950 specifically notes it’s use for identification and lateralization of cerebral seizure focus while the other 3 codes represent localization of cerebral seizure focus.  Lastly, code selection depends on other factors involved in the procedure, such as the use of video recording and if the procedure is attended or unattended.

 

There are similarities between the four (4) AEEG codes: each code is billed once for every 24-hour time period.  Sometimes it is necessary to collect information over a period of 2 – 3 days, or longer and you would report each code once per 24-hour time period.  Another commonality between all codes is the use of Modifier – 52 (Reduced Services).  The CPT Assistant[ii] tells us to append Modifier – 52 to the claim if the provider performs monitoring for 12 hours or less.  Also, if you are only reporting the professional component of one of these codes, Modifier – 26 (Professional Component) should be appended and if only the technical component is applicable, append Modifier – TC (Technical Component) to the claim.  Finally, always check payor guidelines for performing/billing AEEGs as these procedures commonly require prior authorization for medical necessity.

 

What to look for?
When reviewing these codes for potentially inappropriate billing, look for:
  • Billing codes more than once in a 24-hour period
  • Billing of 95956 in a nonfacility setting[iii] as it is considered rare
  • Ensure patients have the medical history and diagnoses that support  these procedures.
[ii]CPT Assistant,  February 2011; Volume 21: Issue 2
[iii] CPT Assistant, December 2009; Volume 19: Issue 12
If you would like to learn more about Healthcare Fraud Shield’s analytics solution, contact us at info@hcfraudshield.com.
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