Billing and Coding Electroencephalogram (EEG) Procedures

An electroencephalogram (EEG) is a safe and effective diagnostic test that employs tiny electrodes affixed to the scalp for gauging the brain’s electrical activity. Neurologists and other specialists use EEG tests to diagnose, monitor, and plan treatment for seizures, brain tumors, head injuries, strokes, and other brain conditions.EEG procedures are complex as they involve various techniques and durations, from standard recordings to extended monitoring, sleep studies, and specialized analyses. Determining the appropriate CPT code necessitates understanding the nuances of each procedure. Coding for EEG must also adhere to regulatory guidelines and payer-specific requirements. The support of an experienced medical billing and coding outsourcing company can go a long way in helping providers meet these compliance standards while accurately coding for services rendered.

Types of Electroencephalogram (EEG)

EEG is conducted while the patient is both awake and asleep to capture comprehensive brain function. There are different types of EEG and the neurologist will recommend the option the patient needs based on the symptoms they are experiencing. Here are five different types of EEG procedures:

1. 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.

2. 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.

3. 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.

4. 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.

5. Inpatient intracranial EEG with video monitoring – This involves surgery to place electrodes in or on the brain’s surface. They may be positioned either in a strip or grid formation, or positioned on slender wire probes. Intracranial EEG requires admission to an inpatient epilepsy monitoring unit (EMU) for video monitoring and comprehensive testing.

Coding EEG Procedures

Interpreting EEG procedures involve analyzing complex brain wave patterns, identifying abnormalities, and writing detailed reports. The provider needs to ensure detailed documentation of the EEG procedure, including factors like the number of channels, duration of recording, awake/asleep states, and the purpose of the test (diagnostic, monitoring, localization). This complex information has to be translated into accurate CPT codes that reflect the level of service provided.

Routine “resting” (EEG) – recording of less than a 24-hr continuous duration

• 95812 Electroencephalogram (eeg) extended monitoring; 41-60 minutes
• 95813 Electroencephalogram (eeg) extended monitoring; 61-119 minutes
• 95816Electroencephalogram (eeg); including recording awake and drowsy
• 95819 Electroencephalogram (eeg); including recording awake and asleep
• 95822 Electroencephalogram (eeg); recording in coma or sleep only

Routine resting” (EEG) must be performed prior to performing an ambulatory continuous EEG. A claim for the routine EEG must have been submitted to Medicare with a date of service (DOS) within 1 year of the DOS of the ambulatory EEG.

Long-term EEG Monitoring – 95705-95726

To accurately code long-term EEG monitoring, healthcare providers must consider the duration of the monitoring, the involvement of video recording, and the professional interpretation and report. Professional component (physician work) 95717 – 95726 and technical component (technologist work) 95700, 95705 – 95716 of the services are reported separately. Here are the main codes within the 95705-95726 range:

• Technical Services
  • Long-term EEG Setup

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 (95700 should be reported once per recording period)

• Monitoring

95705 Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist, 2-12 hours; unmonitored

• 95706 with intermittent monitoring and maintenance
• 95707 with continuous, real-time monitoring and maintenance
• 95708 Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist, each increment of 12-26 hours; unmonitored
• 95709 with intermittent monitoring and maintenance
• 95710 with continuous, real-time monitoring and maintenance
• 95711 Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, 2-12 hours; unmonitored
• 95712 with intermittent monitoring and maintenance
• 95713 with continuous, real-time monitoring and maintenance
• 95714 Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; unmonitored
• 95715 with intermittent monitoring and maintenance
• 95716 with continuous, real-time monitoring and maintenance

Note: 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.

• Professional Services
  • 95717 Electroencephalogram (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
  • 95718 with video (VEEG) (For recording greater than 12 hours,
  • 95719 Electroencephalogram (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
  • 95720 with video (VEEG)
  • 95721 Electroencephalogram (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
  • 95722 greater than 36 hours, up to 60 hours of EEG recording, with video (VEEG)
  • 95723 greater than 60 hours, up to 84 hours of EEG recording, without video
  • 95724 greater than 60 hours, up to 84 hours of EEG recording, with video (VEEG)
  • 95725 greater than 84 hours of EEG recording, without video
  • 95726 greater than 84 hours of EEG recording, with video (VEEG)

Note: Do not report 95721, 95722, 95723, 95724, 95725, 95726 in conjunction with 95717, 95718, 95719, 95720.

EEG procedure codes should be appropriately linked with accurate ICD-10 codes for reimbursement and demonstrating medical necessity. Thorough documentation and coding knowledge is critical to prevent claim denials, delays in reimbursement, and potential compliance issues. Collaborating with a competent neurology medical coding expert can help providers navigate these challenges. Experienced coders have a deep understanding of EEG procedures and stay updated with coding guidelines, ensuring accurate and compliant coding and billing for optimal reimbursement.