Central Resource for EEG SSEP NIOM PSEG ENDT Technicians

Electro - Neuro -Diagnostics ( END )

The purpose of this site is to provide a collaboration of information, opinions and experiences in the field of Electroneurodiagnostics.

What is Electroneurodiagnostics?
Electroneurodiagnostic [END] technology is the allied health care profession that analyzes and monitors nervous system function to promote the effective treatment of neuropathological conditions. Technologists record electrical activity arising from the brain, spinal cord, peripheral nerves, somatosensory or motor nerve systems using a variety of techniques and instruments.

6 Tips to Ace CPT® 2020’s New Long-Term EEG Codes
Deborah MarshMon, Oct 7, 2019 -- Coding Updates, CPT Codes
CPT® 2020 is overhauling long-term electroencephalography (EEG) coding, as Part 3 of our CPT® update series reported. Read on for more helpful hints to prepare you for the new EEG codes and guidelines, effective Jan. 1, 2020.
The 2020 CPT® code set will delete EEG monitoring codes 95950, 95951, 95953, and 95956. The first code applies to identification and lateralization of cerebral seizure focus, and the final three apply to localization. Payers will not accept these deleted codes for services on or after Jan. 1, 2020.
Code 95827 for all-night recording also will be obsolete, and don’t miss the revision to routine EEG code 95813. That extended monitoring code will change its timeframe from “greater than 1 hour” to “61-119 minutes.” When you need to code two hours or more for 2020 dates of service, you’ll choose from new codes 95700-95726.
Tip 2: Read the Guidelines for Official Rules on Proper Use
Use new codes 95700-95726 for long-term (two hours or more) continuous recording services for EEG performed to distinguish seizures from other issues, pinpoint seizures’ location or type, monitor treatment of seizures and status epilepticus, determine if a patient is an epilepsy surgery candidate, or screen for adverse changes in patients who are critically ill.
Where can you find gems like this about when the new codes apply? In the new guidelines that precede 95954 in the code book or that are available with the codes in your online medical coding package. (The new codes are out of sequence, placed after +95967.) These guidelines are essential reading for neurology coders and others involved in reporting these EEG services.
Tip 3: Divvy Up Your Professional and Technical Coding
In line with how providers perform these EEG services, CPT® 2020 adds 95700-95716 for the technical component and 95717-95726 for the professional component.
Technical: The first technical code represents setup and the other services listed in the descriptor: 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). Don’t miss the requirement that an EEG technologist is the one performing the service.
The other technical codes (95705-95716) represent monitoring, maintenance, data review, and creation of a technical summary. Choose from the codes based on these elements in the documentation:
  • Use of diagnostic video recorded simultaneously with the EEG (also called video EEG or VEEG)
  • Nature of the technologist’s monitoring: unmonitored, intermittently monitored, continuously monitored.
Professional: These are the factors you’ll need to know for coding the professional interpretation of EEG (95717-95726):
  • Length of the recording the physician or other qualified healthcare professional (QHP) interprets
  • The timing of report generation by the physician or QHP (daily or after the study is complete).
The professional codes don’t include E/M services, so according to CPT® rules you may separately report E/M codes when there’s documentation to support it. As always, check individual payers’ policies about reporting specific services so you know the rules that apply to those claims.
Tip 4: Know Monitoring Limits to Avoid Coding Mistakes
Technical EEG codes 95706 (2-12 hours), 95709 (12-26 hours), 95712 (with video, 2-12 hours), and 95715 (with video, 12-26 hours) all refer to “intermittent monitoring and maintenance.” The guidelines clarify that “intermittent” means real-time review by the qualified EEG technologist at least every two hours during the recording period. The technologist may monitor up to 12 patients at the same time. If there are more than 12 patients, then you must report all of the studies as unmonitored, the guidelines state.
Tip 5: Verify Percent Recorded for VEEG Codes
To use the video EEG (VEEG) codes 95711-95716, diagnostic video of the patient must be recorded for 80 percent of the VEEG service. If the record doesn’t support that minimum of 80 percent, you must report the service as an EEG without video.
Tip 6: Watch for Opportunity for Extra ‘2-12 Hour’ Code
EEG codes 95705-95707 and VEEG codes 95711-95713 apply to services lasting two to 12 hours. The guidelines clarify the time refers to total diagnostic recording time. If diagnostic recording stops, timing stops. Resume timing when diagnostic EEG resumes.
You also may use one of these codes for “the final increment of a multiple-day service when the final increment extends 2 to 12 hours beyond the time reported by the appropriate greater-than-12-hour-up-to-26-hour code(s).”
An example will help clarify what that quote means. A table accompanying the codes shows that you should report technical services with intermittent monitoring with video for 84 hours this way:
  • Three units of 95715 (Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, each increment of 12-26 hours; with intermittent monitoring and maintenance)
  • One unit of 95712 (Electroencephalogram with video (VEEG), review of data, technical description by EEG technologist, 2-12 hours; with intermittent monitoring and maintenance).
As you can see, you should add 95712 x1 to represent the additional time beyond what 95715 x3 captures.
For the professional component of that same service with a report every 24 hours, you’d assign these codes, according to the table:
  • Three units of 95720 (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; with video (VEEG))
  • One unit of 95718 (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; with video (VEEG)).
What About You?
Do you report long-term EEG services? Do you think these new codes match with the services you see?
Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

Trickle Down Medicine

ByMarilia GarciaAugust 16, 2017
When looking at annual reports, one could not help to notice the business attitude of healthcare companies in the United States. We spent 3.2 trillion dollars on healthcare last year alone; this is almost three times as Italy’s National budget. The medical industry’s commercialization is growing every year, money increasingly dictates where our health resources are placed. Families are forced to pay an enormous amount of bills when leaving a hospital for a life-threatening emergency. Hence, patients often avoid going to see a doctor because of the fear of overpriced treatments. Commercialized healthcare has made the medicinal world less healing and more destructive. It has affected many aspects like the quality of care, the research being conducted, and the amount of duplicated drugs in the market.
The foundation of medicine is no longer built on saving lives but, rather, bankrolling them.
Click to tweet
In today’s world, patients are lucky their doctor studies their symptoms for more than five minutes. Physicians are given a tremendous amount of cases everyday, which decreases the quality of care each individual receives. Caregivers often view patients as a lead way to their paycheck and not as human beings who desire to be cured. This behavior damages the doctor patient relationship in the healthcare system. According to Roni Caryn Rabin from PBS, the less communication a patient receives, the more likely they are to leave the practice confused or angry. Usually, a doctor that is pressured by time does not listen to every concern the patient has, as a result, these repeated cycles could often lead to medical malpractice. An oncologist in Michigan, was accused of administering chemotherapy to patients with a zero survival rate in order to charge their corresponding insurance (Youn, CNN, 2013). This incident clearly depicts one of the many faults of the subsidized medicine in the United States.
A study performed in 1999, encountered that physicians would only allow the patient to speak for 23 seconds before deflecting them onto another subject, and only one in four patients were able to complete their phrase ( Rabin, PBS, 2014). Doctors are given substantial amounts of cases to review in short periods of time, which could make mindful diagnosing close to impossible. If the caregiver is not listening to the patient’s concerns, this may impair his or her ability to gain awareness to what is going on. From working in a medical practice, I have discovered that patients are often scheduled between 5-10 minute intervals. There are cases that tend to be more complex and therefore slows down the consultation. As a doctor, when patients are in a room, you move your wrist to see the time and realize you are more than ten minutes late. Therefore, they start speeding the process in order to be able to finish on time. In many areas of work, people hurry to finish the last task on their desk, but the main difference here is that these aren’t files to be put in a cabinet, but someone’s life that is at stake.
“As a physician you are not only avoiding mortality but aiding morbidity” As Laura Lacquer, a Harvard MD graduate describes, medicine is not always about saving a life but improving the quality of it as well. Trusting a physician is one of the main aspects of health care, but once this relationship occurs in a commercialized environment, the patient should be filled with doubt. When a person being treated believes she is just a number, her trust can quickly dissolve. Who has not heard the allegations that doctors only want your money? This complaint comes directly from people who are under a system that involves subsidized medicine, in which they are often treated as a statistic.
Research is the overlooked blueprint of the medicinal world, commercialization of medicine as a whole, deeply affects the research being conducted. For instance, Stem cell research is currently at its peak of popularity, which provides a perfect ground for commercialization to take place. Therefore, the funds are given to study only the elements of Stem cell than could be easily distributed to the general population. Company executives will usually pressure scientists to follow their agenda for more profitable products and thus skew the research conducted. The powerful companies funding the research are not looking for breakthroughs, but are more determined to market the findings afterwards. The companies that provide the capital lead academic institutions to focus on a specific product. There has even been evidence found of data withholding when commercialized research takes place. This is, perhaps, the most alarming part of it all, research data is hidden from the public because it just is not profitable.
A news entry from S.Z Berg, a journalist from the Huffington post, followed a family with a daughter that suffered from a rare disease called Sanfillipo Syndrome- Type A. The family went to extreme lengths to find funding for their daughter’s rare disease, since government funding would not cover it. According to Berg’s article, there are more than 6,000 unexplained diseases that affect anywhere from 20 to 30 million people. These diseases do not acquire government funding because the treatments would not be lucrative. These are millions of families left with no explanation or cure to their loved one’s sickness. Medicine should not be driven on quantity basis. We all have the same body, but the way our bodies react is always different. There is not a formula that will fix any human being therefore, why are we treating people based on quantity?
The pharmaceutical sector in commercialized medicine is perhaps the most troubling. A drug needed for life-threatening purposes could be increased, in price, any percentage a company would want. In an article by Mathew Herper, a Forbes journalist, the false inflation of a drug’s price in the U.S is shown after seeing the same drug being sold at a steady price all around the globe. The article sets its focus on a steroid called deflazacort, the steroid is used to treat children with muscular dystrophy. Deflazacort contains fewer side effects than other steroids in the market. The drug was sold initially from 1,000 to 2,000 dollars a year, and was increased to 89,000 USD after being FDA approved. Only 7 to 8 percent of the people had access to the drug as a result of the price increase. These price increases would make the drugs unattainable for many low-income families. There were many times that my dad, a chronic gout sufferer, would obtain his pain management medicine from Cuba, simply because the price in the U.S was out of his reach. This overpricing also leads to duplication of drugs in the market, which can create an adverse situation. Many of the duplicate drugs are not well regulated and can cause dangerous side effects.
A lot of the medication prescribed is often due to courtship provided from drug companies to medical practices. In my experience, working in a pediatric office, lunch was provided from these companies and they would hold presentations with the doctors regarding the drugs. Some companies would visit more often, which meant that we used their drugs more frequently. This was always kind of concerning to me, how is it that they are lobbying medication? In many instances they were doing just that. I would notice that after these meetings there was an increase in these drugs being prescribed.
Admittedly, there are also some benefits to commercializing medicine, the research that is profitable will in fact be able to help some patients. Therefore, patients are at least being treated by a physician, even if they are not receiving the best care. Some patients will not need more than 5-10 minutes with a doctor. Furthermore, the increase in the price of pharmaceuticals will still reach a percentage of patients and duplicate drugs, are there as an optional route? Yet, I would argue that the negative outweighs the positive in this situation. The healthcare industry should not commercialize people’s health. It is very dangerous to bring in a business in which corresponds to saving people’s lives. Quantity doesn’t wave quality in this instance. Money playing a major role in medicine could cause unethical outcomes in which human beings are seen as currency (McCormick, 2010).
The future state of healthcare in the US seems to keep declining, even though there is an awareness of the problem with commercializing medicine, the infrastructures of the capitalist system keep encouraging this behavior. The amount of revenue does not reflect success within the medical field, but rather, the loss of humanized care. Commercializing healthcare not only affects the quality of care the patient receives, but the research being conducted to better morbidity. The relationship between a patient and their doctor should be as honest as it can be to avoid malpractice and distrust. All three sectors of medicine should be held to the same transparent standards. Spreading awareness of this issue, will help make the future of medicine brighter. Patients deserve to hold certainty that their caregiver is trying everything in their power to aid them.