Several new CPT codes and guidelines take effect January 1, 2020. One of the most notable changes is the overhauling of the codes for reporting long term electroencephalographic (EEG) monitoring services. There are also updates to special EEG tests guidelines and definitions in 2020. Neurologists, family practice and general practice physicians, physicians in internal medicine, and other specialists involved in the care of patients with seizures and epilepsy need to understand the usage of the new codes and their potential impact on patient care. Relying on a medical billing company with expertise in neurology and internal medicine medical billing is the best option for physicians to ensure billing and coding efficiency.
EEG is one of the most reliable tools to detect and investigate epilepsy. The electroencephalogram (EEG) detects electrical activity in the brain through electrodes that are attached at measured positions on the scalp at rest or sleep. An EEG picks up on the brain waves, which may show irregularities of activity, amplitude, pattern, or speed. EEG is used in combination with other neurodiagnostic tests to evaluate seizure focus, sleep and metabolic disorders, dementia, and brain death.
Long-term EEG Coding Changes for 2020
- Deletion of five CPT codes: The following codes have been deleted
- New codes separate the professional component from the technical component: Professional component (physician work) 95717 – 95726 and technical component (technologist work) 95700, 95705 – 95716 of the services will be reported separately.
Two subsections have been added in Special EEG Tests:
- Long-term EEG Setup
95700 – EEG Technologist service
95705 – 95716 EEG Technologist service
95717 – 95726 Physician or Other Qualified Health Care Professional service
- Reporting new technical component codes 95700-95726
- 95700 Electroencephalogram (EEG) continuous recording, with video when performed, setup, patient education, and take down when performed, administered in person by EEG technologist, minimum of 8 channels
- 12 new codes for TC Services: Monitoring (95705-95716)
- Review of EEG/VEEG data
- Written technical description of data and interventions
Routine Electroencephalography (EEG)
95827 Electroencephalogram (EEG); all night recording
Special EEG Tests
95950 Monitoring for identification and lateralization of cerebral seizure focus, electroencephalographic (eg, 8 channel EEG) recording and interpretation, each
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
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
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
These time-based codes include:
Reporting the New long-term EEG Codes – Points to Note
- As 95700 is for the setup and takedown, it is only billed once per recording period on the date the setup was performed.
- Reporting of codes 95705-95716 is based on the following elements:
- Use of diagnostic video recorded simultaneously with the EEG (also called video EEG or VEEG)
- Duration of recording
- Type of monitoring: Unmonitored, Intermittent, or Continuous, real-time
- Codes 95705, 95706, 95707, 95711, 95712, 95713 may be reported a maximum of once for an entire longer-term EEG service to capture either the entire time of service or the final 2-12 hour increment of a service extending beyond 26 hours. The guidelines clarify the time refers to total diagnostic recording time. If diagnostic recording stops, timing stops. Timing should be resumed when diagnostic EEG resumes.
- When using video EEG codes 95711-95716, TCI Super Coder cautions that the patient’s diagnostic video must be recorded for 80 percent of the video EEG service. If the record does not support this 80 percent, the service should be reported as an EEG without video.
- Reporting new professional component codes 95717-95726 is based on the following elements (www.supercoder.com) –
- Length of the recording interpreted by the physician or other qualified healthcare professional (QHP)
- Timing of report generation by the physician or QHP (daily or after the study is complete)
- As the professional codes do not include E/M services, E/M codes may be reported separately along with proper supporting documentation.
Physicians can rely on outsourced neurology and internal medicine medical billing services to submit accurate claims for long-term EEG services. Medical billing and coding companies have expert teams that would be knowledgeable about the new coding and billing EEG guidelines as well as individual payers’ policies about reporting specific services.