Healthcare Fraud Shield’s Latest Article:  Long-Term Electroencephalograms

25 Oct

Billing for long-term electroencephalograms (EEGs) may feel intimidating, but it doesn’t have to be. Read on to understand how to break it down.

An EEG is a test of brain waves or the electrical activity of the brain. It is performed by attaching multiple electrodes to the scalp, which in turn detect electrical charges associated with brain cell activity.[1] This type of test is used in the evaluation of epilepsy, brain lesions or tumors, Alzheimer’s disease, narcolepsy, and other disorders.

EEGs are divided into routine and long-term services, including some code variations for ambulatory EEGs. For this discussion we’ll focus on long-term EEG/VEEG (Electroencephalogram with video), which is defined as two hours (120 minutes) or longer. The CPT codes used for EEG/VEEG billing are within the range 95700-95967 Special EEG Testing Procedures.[2] New American Medical Association (AMA) Current Procedural Terminology (CPT) codes for EEGs were released, effective 1/1/2020.

If you are billing or auditing services prior to that date, be sure you are using the applicable code set.
Long-term EEG/VEEG includes three coding components:

  • First there is setup of the continuous recording equipment to the patient, which is performed by an EEG technologist. This activity is billed with CPT code 95700 EEG Continuous Recording. In addition to setup, this procedure code includes patient education and takedown of the equipment after the test. This procedure code is billed once per recording period.[3]
  • Next is monitoring of the EEG/VEEG test itself. This activity is performed by an EEG technologist, who also reviews the data that is collected and provides a technical description of the test. This is the technical component of the EEG/VEEG. CPT code range 95705-95716 Long-term EEG Monitoring is used to report these services. For this technical component, code selection is based on[4]:
  1. With or without video 
  2. Length of recording time
  3. Level of monitoring (unmonitored, intermittent, continuous)
  • Finally, the test results are interpreted and reported by a physician or other qualified healthcare professional. CPT code range 95717-95726 Long-term EEG Monitoring is used to report this professional component. Code selection for this part of EEG/VEEG is based on:
  1. With or without video
  2. Length of recording time
  3. Timing of report (periodically throughout the test or upon completion)

CPT Section Specific Guidelines provide a helpful aid (shown above) for selecting codes for these three EEG/VEEG coding components. Be sure to use this resource when billing or auditing long-term EEG/VEEG codes.

Possible schemes:

  • Providers billing significantly more EEG/VEEGs than their peers may indicate billing for services not rendered. However, ensure each provider’s specialty is recorded correctly for accurate peer comparison.
  • Patients with no claim history from the referring or ordering provider may be an indication of services that are not ordered, not necessary or not performed.
  • Frequent or exclusive use of CPT code 95716 may reflect upcoding within CPT code range 95705-95716 (monitoring by EEG technologist) for a higher level of technical component.
  • Billing CPT code 95700 (EEG/VEEG setup) without monitoring (technical component range 95705-95716) or interpretation and report (professional component range 95717-95726) could be an indication of billing for services not rendered or misrepresentation of services.
  • Billing EEG/VEEG setup (95700) and monitoring (95705-95716) without professional interpretation and report (95717-95726) may indicate there was no need for the testing or the service was not performed. Keep in mind EEG setup and technologist services may be billed by a different provider than the one billing for interpretation and report. Be sure to query for all billed services for the member and date of service.

If you have any questions or comments, please reach out to SIU@hcfraudshield.com.


REFERENCES

[1]https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/electroencephalogram-eeg#:~:text=An%20EEG%20is%20a%20test,activity%20of%20your%20brain%20cells

[2]https://www.aapc.com/codes/cpt-codes-range/95700-95967/

[3]https://www.aapc.com/codes/cpt-codes/95700

[4]https://www.aapc.com/codes/cpt-codes-range/95705-95726/

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