Electroencephalography (EEG) is a crucial diagnostic tool in neurology and is employed in various medical institutions. As neurological disorders become more common and EEG becomes more important for diagnosis and monitoring, healthcare providers need to know how to use EEG CPT codes correctly. The professionals at Allzone put together this complete guide to help clinics, hospitals, and neurology practices improve their EEG billing process and make sure they get paid correctly.
What is EEG and why is it important?
It is safe to use EEG to keep track of the brain’s electrical activity. People often use it to look for epilepsy, a sleep disorder, encephalopathy, a brain tumour, or to keep an eye on how the brain is working during surgery or when someone is in critical care. It is important to correctly read and bill for EEGs so that you can take good care of your patients and keep your practice’s income steady.
How to Understand EEG CPT Codes:
Current Procedural Terminology (CPT) codes are the official codes for medical, surgical, and diagnostic services. Using EEG CPT codes correctly helps keep claims from being denied or audited and makes sure that healthcare providers get paid the right amount for the services they provide.
Here are the most important CPT codes for EEG services, along with their meanings and when to use them:
95812 is the name for an electroencephalogram (EEG) that lasts 41 to 60 minutes.
This code is for EEG tests that take 41 to 60 minutes. It includes both awake and sleepy states, and people usually use it when they need a quick but thorough check.
95813: Electroencephalogram (EEG); more than an hour.
This code is for EEG recordings that go on for more than an hour. People who don’t have a lot of events or who need a more thorough evaluation may need to be watched for a longer time.
95816—Electroencephalogram (EEG); awake and asleep.
The standard EEG lasts between 20 and 40 minutes and can be done while you are awake or asleep. This is the EEG code that is most commonly used in outpatient settings.
95819: Electroencephalogram (EEG) while you are awake and while you are asleep.
This code is used to charge for EEGs that record both waking and sleeping. It is very helpful for kids and adults who might have seizure disorders that happen while they are sleeping.
95822—An electroencephalogram that only works when the person is asleep or in a coma
This is for people who are in a coma or who only have an EEG done while they are asleep. It is very important to find out if someone has brain death or encephalopathy.
95957: Looking for spikes and seizures in an EEG using digital analysis.
This code is for more complicated digital analysis, like using a computer to help find seizures and spikes. When digital data is processed, it is often charged with regular EEG codes.
More EEG CPT Codes and What They Are Used For 95810: Polysomnography; this is a sleep study with EEG that is used to find out if someone has a sleep disorder.
95827: Sleep deprivation EEG, which is done when the patient hasn’t slept in a while to make it more likely that problems will be found.
95700–95726: Long-term EEG monitoring (inpatient or outpatient) is used to keep an eye on EEG for several hours or days, usually in epilepsy monitoring units.
96020: Watching neurophysiology during surgery, like with an EEG.
How to fix billing problems:
1. Documentation: There is no doubt that the procedure, how long it took, and the specific clinical reasons for it all need to be written down correctly. The medical record should clearly show why the code was charged, such as how long it took, the patient’s condition, and any treatments given.
2. Bundling and Unbundling: Each payer has its own rules for bundling, so make sure you know what they are. Some insurance companies might use EEG codes with other tests or treatments for the brain. Read the payer’s rules and contracts to get fewer denials.
3. Using Modifiers: It’s very important to use modifiers correctly, such as -26 for the professional part and -TC for the technical part. This is especially true when you are billing for services done in a hospital instead of an office or when only the technical or interpretation part is done.
4. Medical Necessity: Always make sure that the EEG is medically necessary and follows the rules of the payer. If you want your claims to go through, you need to use the right ICD-10 codes to support the service.
5. Staying Up to Date: Payer policies, EEG CPT codes, and documentation requirements can all change. To stay in compliance, you should check for updates from the American Medical Association (AMA), the Centers for Medicare & Medicaid Services (CMS), and major payers on a regular basis.
Best Ways to Get Paid for EEG:
Teach your workers how to code and bill for EEGs.
Before you file a claim, checklists can help you make sure you have all the paperwork you need.
Do internal audits every once in a while to find and fix problems.
Hire billing companies with a lot of experience, like Allzone, to make it easier to handle the revenue cycle for EEG services.
How Allzone Can Help:
Allzone offers professional EEG billing services to healthcare providers and neurology practices all over the country. To help your practice get the most money back and the fewest denials, our team keeps up with changes in coding, payer trends, and compliance requirements. If you hire a reliable company to handle your EEG billing, you can improve your revenue cycle and have more time to care for your patients.
In short, electroencephalography is an important part of modern medicine, and you need to use the right codes to get the most money back. Healthcare providers can avoid expensive audits and denials by using the right EEG CPT codes, keeping good records, and following billing rules. Let Allzone handle the difficult parts of EEG billing so that your neurology practice can continue to grow.
If you want personalised help or want to learn more about Allzone’s medical billing solutions, call us today.