How To Use CPT Code 95816

CPT 95816 is an electroencephalogram (EEG) procedure that measures the electrical activity of the brain during awake and drowsy states. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 95816.

1. What is CPT 95816?

CPT 95816 is a diagnostic test that uses small electrodes attached to the scalp to measure the electrical activity of the brain during awake and drowsy states. This procedure is commonly used to diagnose epilepsy, sleep disorders, and other brain disorders. It is essential for medical coders and billers to understand the proper usage and documentation requirements for this code.

2. 95816 CPT code description

The official description of CPT code 95816 is: “Electroencephalogram (EEG); including recording awake and drowsy.”

3. Procedure

The 95816 procedure involves the following steps:

1. The patient is positioned comfortably in a chair or on a bed.
2. Small electrodes are attached to the patient’s scalp using a special adhesive.
3. The electrical activity of the brain is recorded during both awake and drowsy states.
4. The provider may also perform additional tests, such as hyperventilation or photic stimulation, if appropriate.
5. The recorded data is analyzed to identify any abnormalities in the brain’s electrical activity.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 95816 services include those with suspected epilepsy, sleep disorders, or other brain disorders that may cause abnormalities in the EEG reading. The provider must determine that the EEG is medically necessary for the patient’s diagnosis and treatment.

5. When to use CPT code 95816

It is appropriate to bill the 95816 CPT code when the provider performs an electroencephalogram to measure the electrical activity of the brain during awake and drowsy states. This code should be used when the goal is to assess the brain’s electrical activity that varies with the level of alertness, such as diagnosing epilepsy, sleep disorders, or other brain disorders.

6. Documentation requirements

To support a claim for CPT 95816, the following information should be documented:

• Patient’s medical history and symptoms that justify the need for an EEG.
• Details of the procedure, including the placement of electrodes and the recording of brain activity during awake and drowsy states.
• Any additional tests performed, such as hyperventilation or photic stimulation, and their results.
• Interpretation of the EEG data, including any identified abnormalities and their potential impact on the patient’s diagnosis and treatment plan.

7. Billing guidelines

When billing for CPT code 95816, it is important to follow these guidelines:

• Append professional component modifier 26 if reporting only the professional component for the service.
• Append technical component modifier TC if reporting only the technical component for the service, unless the hospital provided the technical component. In that case, do not append modifier TC.
• Do not append a professional or technical modifier when reporting a global service in which one provider renders both the professional and technical components.
• Do not report CPT 95816 in conjunction with codes 95700 – 95726.

8. Historical information

CPT 95816 was added to the Current Procedural Terminology system on January 1, 1991. The code was changed on January 1, 2003, with the previous descriptor being “Electroencephalogram (EEG) including recording awake and drowsy (including hyperventilation and/or photic stimulation when appropriate).”

9. Similar codes to CPT 95816

Five similar codes to CPT 95816 and how they differentiate are:

• CPT 95812: This code is used for an EEG with a minimum of 41-60 minutes of recording time, without video monitoring.
• CPT 95813: This code is used for an EEG with a minimum of 61-120 minutes of recording time, without video monitoring.
• CPT 95819: This code is used for an EEG with video monitoring, including recording awake and asleep.
• CPT 95822: This code is used for an EEG with video monitoring, including recording awake, asleep, and during a seizure.
• CPT 95827: This code is used for an EEG with video monitoring, including recording during a seizure and postictal period.

10. Examples

Here are 10 detailed examples of CPT code 95816 procedures:

1. A patient with a history of seizures undergoes an EEG to determine if they have epilepsy.
2. A patient with suspected sleep apnea undergoes an EEG to assess their brain activity during drowsy states.
3. A patient with a history of unexplained fainting episodes undergoes an EEG to rule out a neurological cause.
4. A patient with a traumatic brain injury undergoes an EEG to monitor their brain activity during recovery.
5. A patient with a suspected brain tumor undergoes an EEG to assess the impact of the tumor on brain function.
6. A patient with a history of migraines undergoes an EEG to determine if there is an underlying neurological cause.
7. A patient with suspected narcolepsy undergoes an EEG to assess their brain activity during drowsy states.
8. A patient with a history of unexplained episodes of confusion undergoes an EEG to rule out a neurological cause.
9. A patient with suspected encephalitis undergoes an EEG to assess the impact of the infection on brain function.
10. A patient with a history of unexplained behavioral changes undergoes an EEG to determine if there is an underlying neurological cause.