Billing and Coding: EEG – Ambulatory Monitoring

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for EEG - Ambulatory Monitoring. Coding Information: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported. Documentation Requirements: The patient's medical record must contain documentation that fully supports the medical necessity for services included within the LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. Monitoring beyond 72 hours must be supported by written documentation for each additional 24 hours of monitoring and be made available to Medicare upon request. Utilization Guidelines: The following represent the number of 24-hour segments of recordings for testing: For diagnostic testing – Two or three days is usually sufficient when looking for seizures or interictal activity For pre-surgical evaluation – Seven to ten days may be required to capture at least three or four seizures in order to be sure of seizure onset location reliability. Two to three days is usually sufficient for follow-up.