tci Part B Insider - 2013 Issue 41

Reader Question: Awake' or 'Asleep' Distinguishes 95816 From 95819

Question: The neurologist in our group will only read an EEG when the test is performed at a facility. Our previous coder billed 95819-26 for the reading only. Is this correct? Answer: You are correct in appending modifier 26 (Professional component) to the procedure code since the neurologist interpreted the diagnostic results and created the written report instead of conducting the actual diagnostic test. Whether the procedure code being reported is correct depends on an important fact: is the patient awake or asleep during the test? If the patient remains awake during the diagnostic test, report 95816 (Electroencephalogram [EEG]...

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