Regarded as the physiological method of choice, an electroencephalogram (EEG) is a non-invasive test that detects or records electrical patterns in the brain. The brain cells are active all the time and communicate with each other through electrical impulses (even when a person is asleep). An EEG is mainly used to detect potential problems associated with the brain activity through electrodes that are attached at measured positions on the scalp at rest or sleep. The electrical activity of the brain is shown as wavy lines on a recording and these lines allow physicians to quickly assess whether there are abnormal patterns. An EEG picks up on the brain waves, which may show irregularities of activity, amplitude, pattern, or speed. Any irregularities may be a sign of seizures or other metabolic brain disorders. Neurologists and general practice physicians or specialists involved in the performing an electroencephalogram procedure need to correctly understand the usage of the procedure codes and their potential impact on patient care. Relying on the services of reputable medical billing outsourcing companies with ample expertise in this field is the perfect option for physicians to ensure billing and coding efficiency.

Why Is an EEG Done?

In order to track and records brain wave patterns, during an EEG small flat metal discs (called electrodes) are attached to the scalp with wires. The electrodes analyze the electrical impulses in the brain by sending signals to a computer that record the results. Generally, associated with certain brain disorders, the electrical brain measurements produced during an EEG are used to confirm or rule various associated conditions like – seizure disorders (such as epilepsy), dementia, memory issues, brain tumor, stroke, brain damage from a head injury, stroke, sleep disorders, encephalitis (inflammation of the brain) and encephalopathy (disease that causes brain dysfunction). In addition, the procedure is also performed to determine the level of brain activity when a person is in persistent coma and can also be used to monitor activity during brain surgery.

Types of Electroencephalogram (EEG)

The type of EEG requested by a neuro-specialist will depend on the severity of the condition and extent of brain damage. The different types of EEGs include –

  • Routine EEG – This is a basic test performed when a person suffers a seizure for the very first time. Ideally performed within 24 hours (after the occurrence of a seizure), a routine EEG can be done with or without video monitoring to evaluate whether a person has abnormal waves during specific movements of activities.
  • Ambulatory EEG – In this type of test, the patient needs to wear a specific equipment to record the various levels of brain activity on a continuous basis so that patients can go about their normal activities.
  • Sleep EEG or Sleep-deprived EEG – Generally used to test for sleep disorders, the procedure may be used if a routine EEG does not give enough information.
  • Video Telemetry – Also called video EEG, this is a special type of EEG wherein a patient is filmed while an EEG recording is taken to provide more information about brain activity. As part of the procedure, the EEG signals are transmitted wirelessly to a computer and the video is recorded by the computer and kept under regular surveillance by trained staff.

As the test is painless, an EEG for most people does not pose any significant risks. The electrodes used for an EEG only pick up electrical charges; they do not emit electricity and are harmless. In rare cases, an EEG can cause seizures in patients suffering from seizure disorder (which intensify when a patient do not take medication before the test or due to stimuli such as strobe lights or rapid breathing). When a person with epilepsy or another seizure disorder undergoes an EEG, the stimuli presented during the test (such as a flashing light) may cause a seizure. However, the neurologist performing the EEG can safely manage any situation that might occur during the procedure.

What Happens During an EEG – Getting Prepared for the Procedure

Patients planning to undergo an electroencephalogram (EEG), need to get well-prepared for the test. Typically, performed on an outpatient basis, the length of the procedure will depend on the type of EEG a person undergoes. A general or routine EEG can take as little as 20-30 minutes or as many as 24 hours to several days in a hospital, so that the actual brain waves can be measured. In most cases, an EEG test is performed in a hospital or physician’s clinic. On the other hand, in some cases of extended monitoring, patients may be admitted to the hospital for a few days. Patients need to usually eat and drink beforehand and continue to take all the normal medications (unless instructed otherwise by the physician). Patients need to provide a complete list of medications and discuss with the physician in advance whether it is safe to consume these medicines while undergoing the test. In addition, patients need to avoid eating or drinking anything containing caffeine for at least eight hours before the test. In order to help EG small flat metal discs (called electrodes) to stick to the scalp more easily, physicians will generally advise patients to wash the hair and keep it clean and dry ((before undergoing the test). Do not use any products (like sprays or gels) in the hair on the day of the test as these products can make it harder for the sticky patches that hold the electrodes to stick on the scalp. If patients are supposed to sleep during the EEG test, physicians may ask them to sleep less or avoid sleep the night before the test.

During an EEG, patients may feel little or no discomfort as the electrodes may just record the brain waves and do not transmit any sensations. The test that usually takes 30 to 60 minutes to complete involves the following steps –

  • As an initial step, patients may be asked to lie down on their back in a reclining chair or on a bed. The EEG technician will measure the patient’s head and mark the scalp with a special pencil to indicate the area wherein the electrodes need to be attached. These spots are scrubbed with a sticky gel adhesive that helps the electrodes get a high-quality reading of the recording.
  • The technician will attach about 16 to 25 electrodes to spots on the scalp. The electrodes are connected with wires to an instrument that amplifies the brain waves and converts the electrical impulses into visual patterns that appear on a computer screen. Once the electrodes are in place, an EEG typically takes up to 60 minutes. On the other hand, testing for certain conditions require patients to sleep during the test. In such cases, the test can take a longer time.
  • Patients can relax in a comfortable position with their eyes closed during the test. However, at times during the course of the procedure, the technician may instruct patients to open and close their eyes, breathe deeply for a few minutes, read a few paragraphs and look at flashing stimuli (such as a flashing light or a picture). After the test is complete, the technician will remove the electrodes from the scalp.
  • During the test, video is recorded wherein the patient’s body motions are captured while the EEG records the brain waves. This combined recording can help diagnose and treat in a more effective manner.

Neurologists may interpret the recordings from the EEG and then prepare the final results. In an EEG, the electrical activity of the brain appears as a pattern of waves. Several levels of consciousness, like sleeping and waking, have a specific range of frequencies of waves per second that are considered normal. Abnormal EEG results may be due to seizure disorders, abnormal bleeding or hemorrhage, sleep disorders or other brain damage disorders.

CPT Codes for Reporting Electroencephalogram (EEG)

Billing and coding for electroencephalogram (EEG) can be challenging, as it involves numerous rules related to reporting the procedure accurately. Physicians administering EEG must use the relevant CPT codes to bill for the procedure correctly. The CPT codes for electroencephalogram (EEG) include –

  • 95700 – Electroencephalogram (EEG) continuous recording, with video when performed, setup, patient education, and takedown when performed, administered in person by EEG technologist, minimum of 8 channels

12 new codes for TC Services – Monitoring (95705-95716) and these time-based codes include

  • 95705 EEG without video, 2-12 hours; unmonitored
  • 95706 intermittent monitoring, maintenance
  • 95707 continuous, real-time monitoring, maintenance
  • 95708 EEG, without video, each increment of 12-26 hours; unmonitored
  • 95709 intermittent monitoring, maintenance
  • 95710 continuous, real-time monitoring, maintenance
  • 95711 EEG with video, 2-12 hours; unmonitored
  • 95712 intermittent monitoring, maintenance
  • 95713 continuous, real-time monitoring, maintenance
  • 95714 EEG with video, each increment of 12-26 hours; unmonitored
  • 95715 intermittent monitoring, maintenance
  • 95716 continuous, real-time monitoring, maintenance

95717 – 95726 Physician or Other Qualified Health Care Professional service

  • 95717 – EEG, continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation and report, 2-12 hours of EEG recording; without video
  • 95719 – EEG, continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater than 12 hours, up to 26 hours of EEG recording, interpretation and report after each 24-hour period; without video
  • 95721 – EEG, continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 36 hours, up to 60 hours of EEG recording, without video
  • 95723 EEG, continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 60 hours, up to 84 hours of EEG recording, without video
  • 95725 EEG, continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of EEG recording, without video
  • 95725 EEG, continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of EEG recording, without video

It is extremely important for patients to discuss the EEG test results with the neurologists. Before reviewing the final results, it is important for patients to write down any questions they feel like asking.

Physicians can rely on outsourced neurology medical billing services in USA to submit accurate claims for long-term EEG services. Reputable billing and coding companies will offer the services of expert coders who are well-versed about the latest coding and billing EEG guidelines about reporting specific services.

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