Find answers to your most common coding questions:
Can I report 95718 or 95720 for an ambulatory VEEG if I receive a download of the VEEG data every 24 hours instead of a single download at the end of the ambulatory study?
No, it would not be appropriate to report either code for ambulatory studies > 24 hours. 95717 – 95720 are intended for long-term EEG monitoring services where the physician has access to the EEG data throughout the duration of the recording (as is typical for inpatient studies) and generates a daily report for each 24-hour segment of the recording with a summary report at the conclusion of the multi-day studies. If these requirements are not met, the correct code for the professional component would be 95721 – 95726.
AAN does not have the technical services payment posted online, where can I find that?
Medicare did not assign national payment rates for the TC codes, rather made them "contractor priced" which means that rates will be set by each regional Medicare Administrative Contractor (MAC) for their geographic jurisdiction. Each MAC will be responsible for posting their fee schedule and coverage policies. The AAN has guidance online on how to identify the MAC for your region, locate and review a coverage policy.
Can professional code 95718 VEEG, 2-12 hours be billed at either the beginning or ending of a multiple-day study if it is used once? This would be when there are daily reports, but the first report falls within the 2-12 hour period.
No, 95718 should only be reported at the conclusion of a study. Count time continuously from the start of recording. For a multi-day study, the first 24-hour period of 95720 will end during the second calendar day. If the final day includes more than 2 hours beyond a 24-hour period, then use 95718 for that final recording day spanning between 2-12 hours.
We do daily reports at 7 A.M. That means that a study that started at 11 A.M. The first day would be from 11 until 7 A.M. the next day. When the study concludes at two then the last session will be from 7 A.M. until 2 P.M. on the final day. Is that true?
Time is continuous for the start of recording. The 7 a.m. times do not affect the overall duration. A total recording time of 27 hours would be reported as 95720 (x 1) and 95718 (x 1) – (assuming the physician has access during the duration of the recording and is generating daily reports).
We do reports midnight to midnight. Can we continue to do this and use the 95718 for the start of the study?
The parenthetical language following code 95718 states that 95717, 95718 may be reported a maximum of once for an entire long-term EEG service to capture either the entire time of service or the final 2-12 hour increment of a service extending beyond 24 hours. Therefore, you could report 95718 for the time at the conclusion of the study if less than 12 hours on the final day of recording. Time is continuous for the start of recording. Midnights do not affect the overall duration.
Are "unmonitored/13+ patients" technical codes going to be applicable mostly for ambulatory EEG in the home, or are there other situations where they would be used? I.e., how often would you expect to see unmonitored codes used, other than for home-based EEG?
We anticipate the unmonitored TC codes will most frequently be used for ambulatory / in-home studies; however, in any scenario when the intermittent criteria are not met, you would need to report the unmonitored codes. If an EMU or ICU had 20 patients with one monitoring technologist, then the “unmonitored” codes would be reported for the technical services.
Are the codes billed on the day of initiating the study or ending the study?
While the CPT codebook does not specify the date of service that must be reported for a multi-day study, a good coding practice is to use the date the procedure starts. We recommend looking to any policies or workflow you have established in your center; the key is to be consistent among physicians and coders. (If an alternate procedure date is used, we recommend retaining a process document on file for audit or compliance purposes.)
Which code is used for mixed nerve conduction studies?
Each type of study (motor with F-wave, motor without F-wave, sensory, h-reflex) performed on each nerve segment, as listed in "Appendix J" of the CPT code book, counts as one study. Add the number of studies performed to get to the appropriate code (95907-95913).
If I perform a sensory study and a motor study for the same nerve, does that count as one study or two studies?
It counts as two.
If I perform a median motor + sensory and ulnar motor + sensory is that four units (95908) or is that two units (95907) because I only studied two nerves?
This scenario counts as four studies, and you would report one unit of 95908.
Do we count bilateral H reflex studies separately?
Yes, this would count as two studies.
Is an H-reflex study, motor study, and sensory study of the same nerve regarded as three tests?
Yes, the appropriate code would be 95908 (3-4 studies).
Is performing NCS on one nerve considered one study?
Not necessarily. If you perform a motor and sensory study on that one nerve, it would be counted as two studies.
If we bill 95909, do I report one unit or the amount of studies we performed (i.e. five)?
Since the number of studies performed is inherent in the coding structure, the appropriate way to report this service is one unit of 95909 (5-6 NCS studies).
If a patient is scheduled for testing with a diagnosis of carpal tunnel syndrome (CTS), but when the physician examines the patient, the patient complains of lower limb pain and is therefore also tested for peripheral neuropathy, is this bundled as one NCS or is the billed separate because different extremities are tested for different diagnoses?
List all of the diagnoses (ICD-10 codes) on the claim form, listing the most complicated first, but lump all of the studies together, as was previously done. Ultimately, one NCS code (95907-95913) will be used.
Where can we get the full "Appendix J" for 2018?
Access Appendix J. It can also be found in the 2018 CPT book. You can also refer to the Expanded Appendix J for examples of a reasonable number of studies performed per neurology indication.
Are the transitional care codes billed in addition to the face-to-face visit?
CMS requires a face-to-face visit, initial patient contact, and medication reconciliation within specified time frames. The first face-to-face visit is part of the TCM and not separately reported. Additional face-to-face visits within the 30-day period may be reported separately.
When do I submit the TCM codes? Do I submit it the day when you talk to the patient/caregiver, or on the 7th or 14th day when I see the patient for the face-to-face encounter?
The date of service for TCM codes is not the date of the face-to-face visit. The time is still running until day 29 for TCM services. The TCM charges should be submitted 30 days following discharge.
If you submit the 99495 code prior to the 7th or 14th day, what happens if the patient does not show up for follow-up?
Do not submit the code until the follow-up visit physically occurs. Medicare will deny the charges if they are submitted sooner than 30 days from the date of discharge. If you are unable to have a face-to-face follow-up within 7 to 14 days from discharge, you would be unable to bill either of the TCM codes.
What documentation is needed to report a transitional care code?
Within two business days of discharge, an interactive contact with the patient or caregiver must take place. This contact can be face-to-face or by telephone, or by electronic means. A face-to-face visit must take place within 7 or 14 calendar days following discharge, depending on the complexity of the patient and code reported Medication reconciliation and management must take place no later than the date of the first face-to-face visit following discharge.