Billing and Coding for Electroencephalogram (EEG)

Hello everyone and welcome to our podcast series. My name is Natalie Tornese and I’m the Senior Group Manager for Outsource Strategies International (OSI). I wanted to take this opportunity to go over reporting billing and coding for EEGs.

0:16 – Introduction to Electroencephalogram (EEG)

An EEG or electroencephalogram is a non-invasive test that detects or records electrical patterns in the brain. An EEG is mainly used to detect potential problems associated with  brain activity through electrodes that are attached at measured positions on the scalp at rest or at sleep. The electrical activity of the brain is shown as wavy lines on a recording and these lines allow physicians to quickly assess whether there are abnormal patterns. The EEG will pick up on the brain waves, which may show irregularities of activity, amplitude, pattern, or speed. Any irregularities seen may be a sign of seizures or other metabolic brain disorders.

0:59 – Why Is an EEG Done?

In order to track and record brain wave patterns during an EEG, a small flat metal discs (called electrodes) are attached to the scalp with wires. These electrodes analyze the electrical impulses in the brain by sending signals to a computer that record the results. Generally associated with certain brain disorders, the electrical brain measurements produced during an EEG are used to confirm or rule various associated conditions like seizure disorders (such as epilepsy), dementia, memory issues, brain tumors, stroke or brain damage from a head injury, sleep disorders, encephalitis and encephalopathy. In addition, the procedure is also performed to determine the level of brain activity when a person is in persistent coma and also can be used to monitor activity during brain surgery.

1:54 – Types of EEG

The type of EEG requested by a neuro-specialist will depend on the severity of the condition and extent of brain damage. The different types include –

2:02 – A Routine EEG is a basic test performed when a person suffers a seizure for the very first time. This is ideally performed within 24 hours (after the occurrence of a seizure). A routine EEG can be done with or without video monitoring to evaluate whether a person has abnormal waves during specific movements of activities.

2:23 – An Ambulatory EEG is a type of test where the patient needs to wear a specific equipment to record the various levels of brain activity on a continuous basis so that patients can go about their normal activities.

2:38 – A Sleep EEG or Sleep-deprived EEG is generally used to test for sleep disorders. The procedure may be used if a routine EEG does not give enough information.

2:49 – Video Telemetry, also called a video EEG, is a special type of EEG where a patient is filmed while an EEG recording is taken to provide more information about brain activity. As part of the procedure, the EEG signals are transmitted wirelessly to a computer and the video is recorded by the computer and kept under regular surveillance by trained staff.

3:13 – Risk Factors

An EEG for most people does not pose any significant risks. The electrodes used for an EEG only pick up electrical charges; they do not emit electricity and they are harmless. In rare cases, an EEG can cause seizures in patients suffering from a seizure disorder. When a person with epilepsy or another seizure disorder undergoes an EEG, the stimuli presented during the test (such as a flashing light) may cause a seizure. However, the neurologist performing the EEG can safely manage any situation that might occur during the procedure.

3:49 – What Happens During an EEG?

During an EEG test, which is typically performed on an outpatient basis in a hospital clinic, usually takes about 20-30 minutes or as many as 24 hours to several days if you are in a hospital, so that the actual brain waves can be measured. In some cases of extended monitoring, patients may be admitted to the hospital for a few days. Patients may feel little or no discomfort as the electrodes may just record the brain waves and do not transmit any sensations.

4:18 – Patients may be asked to lie down on their back in a reclining chair or on a bed. The EEG technician will measure the patient’s head and mark the scalp with a special pencil to indicate the area wherein the electrodes need to be attached. Those spots are scrubbed with a sticky gel adhesive that helps the electrodes get a high-quality reading of the recording.

4:39 – The technician will attach about 16 to 25 electrodes to spots on the scalp. They are connected with wires to an instrument that amplifies the brain waves and converts the electrical impulses into visual patterns that appear on a computer screen. Once the electrodes are in place, the EEG typically takes up to 60 minutes. On the other hand, testing for certain conditions require patients to sleep during the test. In these cases, of course, the test can take a longer time.

5:07 – Patients can relax in a comfortable position with their eyes closed during the test. However, at times during the course of the procedure, the technician may instruct the patient to open and close their eyes, breathe deeply for a few minutes, read a few paragraphs and look at the flashing stimuli. After the test is complete, the technician will remove the electrodes from the scalp.

5:26 – During this test, video is recorded wherein the patient’s body motions are captured while the EEG records the brain waves. This combined recording can help diagnose and treat in a more effective manner.

5:38 – Billing and Coding for EEGs

Billing and coding for EEGs can be challenging, as it involves numerous rules related to reporting the procedure accurately. Physicians administering the EEG must use the relevant CPT codes to bill for the procedure correctly. I will include a transcript of all associated CPT codes for this procedure along with this recording.

I hope this helps but always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.