How To Use CPT Code 95813

CPT 95813 describes the procedure for extended electroencephalogram (EEG) monitoring that lasts between 61 and 119 minutes. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95813?

CPT 95813 can be used to describe the procedure for extended electroencephalogram (EEG) monitoring that lasts between 61 and 119 minutes. This code is used when a healthcare provider performs an EEG to measure the electrical activity of the brain using small electrodes placed on the patient’s scalp. The extended monitoring allows for a more comprehensive evaluation of brain function and can aid in the diagnosis of conditions such as epilepsy, coma, or sleep disorders.

2. Official Description

The official description of CPT code 95813 is: ‘Electroencephalogram (EEG) extended monitoring; 61-119 minutes.’

3. Procedure

1. The healthcare provider prepares the patient for the extended EEG monitoring by attaching small electrodes to the patient’s scalp.
2. The provider then initiates the monitoring and records the electrical activity of the brain for a duration of 61 to 119 minutes.
3. During the monitoring, the provider may instruct the patient to perform certain tasks or activities to provoke specific brain responses.
4. After the monitoring period, the provider reviews and analyzes the recorded data to assess the patient’s brain function and identify any abnormalities.
5. The results of the extended EEG monitoring can aid in the diagnosis and treatment of various neurological conditions.

4. Qualifying circumstances

CPT 95813 is typically performed when there is a need for extended EEG monitoring to evaluate brain function and diagnose conditions such as epilepsy, coma, or sleep disorders. The procedure requires the use of small electrodes attached to the patient’s scalp to measure the electrical activity of the brain. It is important to establish medical necessity before performing an extended EEG, as payers may require documentation supporting the need for the procedure.

5. When to use CPT code 95813

CPT code 95813 should be used when a healthcare provider performs an extended EEG monitoring that lasts between 61 and 119 minutes. This code is appropriate for situations where a more comprehensive evaluation of brain function is required, such as in the diagnosis of epilepsy, coma, or sleep disorders. It is important to note that CPT code 95813 should not be reported in conjunction with codes 95700-95726, which are used for long-term EEG services lasting 2 hours or more.

6. Documentation requirements

To support a claim for CPT code 95813, the healthcare provider must document the following information:

• Medical necessity for the extended EEG monitoring
• Date and duration of the monitoring (61-119 minutes)
• Specific tasks or activities performed during the monitoring
• Analysis and interpretation of the recorded data
• Diagnosis or suspected condition being evaluated
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 95813, ensure that the procedure meets the criteria for extended EEG monitoring lasting between 61 and 119 minutes. If reporting only the professional component, append modifier 26 to the code. If reporting only the technical component, append modifier TC to the code, unless the technical component was provided by the hospital. Do not append modifiers when reporting a global service where one provider renders both the professional and technical components. It is important to review payer guidelines and requirements for accurate and appropriate billing.

8. Historical information

CPT code 95813 was added to the Current Procedural Terminology system on January 1, 1995. There have been two code changes since its addition, with the most recent change occurring on January 1, 2020. The code was updated to specify ‘greater than 1 hour’ in the previous versions.

9. Examples

1. A neurologist performing an extended EEG monitoring for 90 minutes to evaluate a patient with suspected epilepsy.
2. A sleep specialist conducting an extended EEG monitoring for 75 minutes to assess a patient with suspected sleep disorders.
3. An intensivist ordering an extended EEG monitoring for 100 minutes to evaluate a patient in a coma.
4. A pediatrician performing an extended EEG monitoring for 80 minutes to assess a child with suspected neurological abnormalities.
5. A neurosurgeon conducting an extended EEG monitoring for 110 minutes to evaluate a patient before epilepsy surgery.
6. A psychiatrist ordering an extended EEG monitoring for 70 minutes to assess a patient with suspected psychiatric disorders.
7. A geriatrician performing an extended EEG monitoring for 95 minutes to evaluate an elderly patient with cognitive decline.
8. A rehabilitation specialist conducting an extended EEG monitoring for 105 minutes to assess a patient with traumatic brain injury.
9. A neurophysiologist ordering an extended EEG monitoring for 85 minutes to evaluate a patient with suspected brain tumors.
10. An anesthesiologist performing an extended EEG monitoring for 115 minutes to assess brain function during anesthesia.