How To Use CPT Code 95819

CPT 95819 refers to an electroencephalogram (EEG) procedure that includes recording the patient’s brain activity while awake and asleep. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 95819.

1. What is CPT 95819?

CPT 95819 is a medical billing code used for an electroencephalogram (EEG) procedure that records the electrical activity of a patient’s brain while they are awake and asleep. This diagnostic test is performed using small electrodes attached to the patient’s scalp and is primarily used to diagnose epilepsy and other brain disorders, such as coma or sleep disorders.

2. 95819 CPT code description

The official description of CPT code 95819 is: “Electroencephalogram (EEG); including recording awake and asleep.”

3. Procedure

The 95819 procedure involves the following steps:

1. Preparation of the patient, including cleaning the scalp and attaching the electrodes.
2. Recording the patient’s brain activity while they are awake.
3. Recording the patient’s brain activity while they are asleep.
4. Monitoring and analyzing the recorded data to identify any abnormalities or patterns.
5. Interpreting the results and providing a diagnosis or recommendations for further testing or treatment.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 95819 services include those who:

• Have a history of seizures or epilepsy.
• Are suspected of having a brain disorder, such as a coma or sleep disorder.
• Require monitoring of their brain activity for medical reasons, such as during surgery or following a head injury.
• Are undergoing evaluation for a neurological condition or treatment.

5. When to use CPT code 95819

It is appropriate to bill the 95819 CPT code when a healthcare provider performs an EEG to measure the electrical activity of a patient’s brain while they are awake and asleep. This code is used to diagnose epilepsy, coma, sleep disorders, and other brain disorders that may cause abnormalities in the EEG reading.

6. Documentation requirements

To support a claim for CPT 95819, the following information should be documented:

• Patient’s medical history, including any history of seizures, epilepsy, or other neurological conditions.
• Reason for the EEG, such as suspected brain disorder or monitoring during surgery.
• Details of the procedure, including the preparation, recording, and interpretation of the EEG data.
• Results of the EEG, including any identified abnormalities or patterns.
• Diagnosis or recommendations for further testing or treatment based on the EEG results.

7. Billing guidelines

When billing for CPT code 95819, keep in mind the following guidelines:

• Append professional component modifier 26 if reporting only the professional component of the service.
• Append technical component modifier TC if reporting only the technical component of 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 95819 in conjunction with codes 95700 – 95726.

8. Historical information

CPT 95819 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2003, with the previous descriptor being “Electroencephalogram (EEG) including recording awake and asleep (including hyperventilation and/or photic stimulation when appropriate).”

9. Similar codes to CPT 95819

Five similar codes to CPT 95819 and how they differ are:

• CPT 95812: This code is used for an EEG with a minimum of 41-60 minutes of recording time, without recording during sleep.
• CPT 95813: This code is used for an EEG with a minimum of 61-120 minutes of recording time, without recording during sleep.
• CPT 95816: This code is used for an EEG with a minimum of 21-40 minutes of recording time, without recording during sleep.
• CPT 95822: This code is used for an EEG with a minimum of 20 minutes of recording time, including recording during sleep.
• CPT 95827: This code is used for an EEG performed during the intracarotid amobarbital procedure (Wada test).

10. Examples

Here are 10 detailed examples of CPT code 95819 procedures:

1. A patient with a history of seizures undergoes an EEG to determine if they have epilepsy. The EEG is performed while the patient is awake and asleep.
2. A patient who experienced a head injury is monitored with an EEG while awake and asleep to assess their brain function and identify any abnormalities.
3. A patient with suspected sleep apnea undergoes an EEG while awake and asleep to evaluate their brain activity during different stages of sleep.
4. A patient undergoing brain surgery has an EEG performed while awake and asleep to monitor their brain activity during the procedure.
5. A patient with a history of unexplained fainting episodes undergoes an EEG while awake and asleep to determine if a neurological condition is causing the episodes.
6. A patient with a family history of epilepsy undergoes an EEG while awake and asleep as part of a comprehensive neurological evaluation.
7. A patient with suspected narcolepsy undergoes an EEG while awake and asleep to evaluate their brain activity and sleep patterns.
8. A patient with a history of migraines undergoes an EEG while awake and asleep to determine if a neurological condition is contributing to the migraines.
9. A patient with suspected encephalitis undergoes an EEG while awake and asleep to evaluate their brain function and identify any abnormalities.
10. A patient with a history of unexplained behavioral changes undergoes an EEG while awake and asleep to determine if a neurological condition is causing the changes.