Resolved Video EEGs

[WendyP_55435]

i work for a neurology office that does 12, 24,72 hr EEGs both Video and w/out Video. Im having issues getting my mind "wrapped" around the coding. We bill
95722, 95714, 95700. An example would be pt came in on the 14th started Video EEG it was 48 hour. In my mind it should be 95722 7/16/20, 95714 7/14/20, 95714 7/15/20 and 95700 7/14/20. However I was told it would be 95722 7/15/20, 95714 7/14/20, 95714 7/15/20 and 95700 7/14/20 (which to me shorts the provider a full day) Which one is correct? Where are some good guidelines on this procedure?

 

[Alicia]

Excellent question!
(FYI these are new codes)
Changes were made to electroencephalogram (EEG) long-term continuous recording services in the Special Electroencephalography (EEG) Tests subsection of the 2020 Current Procedural Terminology (CPT®) code set to reflect changes in clinical practice and improvements in long-term EEG services. Two new subsections were created to distinguish between the setup and the actual monitoring services, decoupling the technical component from the professional component of services provided. Introductory guidelines were revised to include new definitions (eg, qualifications of those who are able to perform long-term EEG recording services). A new “Long-term EEG Monitoring Table” was added to help educate users about the new codes. Prior to 2020, long-term EEG could be reported only for each 24-hour period of monitoring using codes 95950, 95951, 95953, or 95956; however, these codes were deleted for 2020. (Coding Assistant 3-2020)

 

[Alicia]

95722 - 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, with video (VEEG)

Long-term electroencephalogram (EEG) continuous recording is done to capture brain wave activity for a period of 2 hours or more. This may be done with video (VEEG) as the patient is monitored over a video screen concurrently for at least 80% of the time that the diagnostic EEG is recording. This allows the physician to observe brain wave activity right when the seizure is occurring. Time is counted when actual EEG recording begins and for as long as recording is taking place. An extended EEG service may be done to diagnose the specific type and location of seizures, monitor current treatment, diagnose a seizure disorder versus another abnormality, and determine if the patient’s epilepsy may be treated surgically. Extended EEG services may also be done on seriously ill patients to screen for new, adverse neurological changes. These codes report the professional component for extended EEG services based on the time of the recording the professional is reviewing, and video provision. The physician or other qualified professional reviews the data from the EEG/VEEG and provides one summary written report with the entire professional interpretation after study completion. The professional review includes a diagnostic analysis of spikes, generated events, and seizure detection, with a diagnostic interpretation of the recorded results, and recommendations based on the findings. Report 95721 for these professional services for more than 36 hours, up to 60 hours of EEG recording, without video and 95722 with video. Report 95723 for these professional services for more than 60 hours, up to 84 hours of EEG recording, without video and 95724 with video. Report 95725 for these professional services for more than 84 hours of EEG recording, without video and 95726 with video.

95714 - Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; unmonitored

Long-term electroencephalogram (EEG) continuous recording is done with video (VEEG) to capture brain wave activity for a period of 2 hours or more while the patient is monitored over a video screen concurrently for at least 80% of the time that the diagnostic EEG is recording. This allows the physician to observe brain wave activity right when the seizure is occurring. Time is counted when actual EEG recording begins and for as long as recording is taking place. An extended EEG service may be done to diagnose the specific type and location of seizures, monitor current treatment, diagnose a seizure disorder versus another abnormality, and determine if the patient’s epilepsy may be treated surgically. Extended EEG services may also be done on seriously ill patients to screen for new, adverse neurological changes. These codes report the technical portion for extended EEG services based on time and monitoring given. This includes the EEG technician’s uploading of the data generated by the EEG equipment; review of the raw data with annotations and edits of recognized events, both patient generated and machine detected; storing or archiving the reviewed data for further review by the physician or other qualified personnel; and a written report documenting his/her review of the data, including any technical interventions. For unmonitored technician services, report 95711 for 2-12 hours and 95714 for 12-26 hours. Report 95712 (2-12 hours) and 95715 (12-26 hours) when provided with intermittent monitoring and maintenance in which the technician also oversees the quality of the EEG recording and provides real-time data review at least every 2 hours during the entire period. Report 95713 (2-12 hours) and 95716 (12-26 hours) when provided with continuous, real-time concurrent monitoring and maintenance during the entire recording period that provides documentation of the monitoring, event recognition, and notification of the physician, per instruction.

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

Long-term electroencephalogram (EEG) continuous recording including video (VEEG), when performed, is done to capture brain wave activity for a period of 2 hours or more. Time is counted when actual recording begins and for as long as recording is taking place. An extended EEG service may be done to diagnose the specific type and location of seizures, monitor current treatment, diagnose a seizure disorder versus another abnormality, and determine if the patient’s epilepsy may be treated surgically. Extended EEG services may also be done on seriously ill patients to screen for new, adverse neurological changes. An EEG technician applies a minimum of 8 electrodes in different positions on the scalp using a sticky paste. More than 15 channels are generally used for older children or adults, while 15 or less may be used on infants. The electrodes are connected by wires to an amplifier and recording machine. The patient is instructed to lie still with the eyes closed. The machine is activated, and the recording period begins. The machine converts electrical signals from the brain into visible wavy lines. This code reports the services of an EEG technician performing the setup and takedown in person for EEG or VEEG continuous recording services done with at least 8 channels.

 

[Alicia]

Coding Tip
Codes 95961 and 95962 may be reported with codes 95700-95726 when functional cortical or subcortical mapping is performed with long-term EEG monitoring.
EEG Monitoring: Professional Component (PC) Services (95717-95726)

Codes 95717-95726 describe the professional services performed by a physician or other qualified health care professional (QHP) for reviewing, analyzing, interpreting, and reporting the results of the continuous recording EEG/VEEG with recommendations based on the findings of the studies. These codes do not include evaluation and management (E/M) services, which may be reported separately. The selection of a PC code is based on (1) length of the recording being interpreted and (2) when the report(s) by a physician or other QHP are generated (ie, whether diagnostic interpretations and reports are made daily during the study or whether the entire professional interpretation is performed only after the full study is completed). Codes 95717-95720 are reported when daily professional reports are generated during the long-term recording, even if the entire study extends over multiple days, or when the time of recording for the entire study is between 2 hours and 36 hours. Codes 95717 and 95718 are reported once for a 2-12 hour recording and are reported a maximum of once for an entire long-term EEG service if the study extends over multiple days. Codes 95719 and 95720 are reported once each day for each 24 hours of a multiple day recording and reported once for a single recording greater than 12 hours up to 26 hours. The recorded data are reviewed, interpreted, and reported daily by the physician or other QHP, and summary reports are made for the entire multiple-day study at the end of the recording period.


Codes 95705-95707, 95711-95713 may only be reported once for the complete EEG service, either for the initial 2-12 hours or for the final 2-12-hour increment when an EEG service that extends beyond 26 hours. Codes 95711-95716 are reported when diagnostic video of the patient is recorded a minimum of 80% of the time, concurrent with diagnostic EEG recording (ie, the entire study is reported as an EEG without video if the length of the concurrent diagnostic video recording is less than 80% of the entire diagnostic EEG recording). Table 1 provides a conceptual framework for reporting the TC of EEG services based on the diagnostic recording time.

Table 1. Conceptual Framework of 12 New TC Codes (95705-95716)
With Video	Duration/Intensity of Monitoring 2-12 Hours	Without Video
95711	Unmonitored	95705
95712	Intermittent Monitoring	95706
95713	Continuous Real-time Monitoring	95707
> 12-26 Hours​
95714	Unmonitored	95708
95715	Intermittent Monitoring	95709
95716	Continuous Real-time Monitoring	95710

For a more comprehensive table of how to report long-term EEG monitoring codes, refer to the Long-Term EEG Monitoring Table on page 715 of the 2020 CPT Professional Edition codebook. Diagnostic EEG recording is an essential component of all long-term EEG services. If diagnostic EEG recording stops, timing stops until the diagnostic EEG recording is resumed.

 

[WendyP_55435]

OH MY GOODNESS thank you very much Alicia! This is great information...

 

[NicoleE_57709]

Alicia you are amazing!!! I really needed this and appreciate your knowledge on this topic