Forum - Questions & Answers

Jan 28th, 2011 - martins 2 

Alternate

95957 is not covered By BCBS of Texas, do we have any alternative CPT® codes

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Jan 28th, 2011 - jschmutz   323 

95957 does have a BX policy

First, make sure that 95957 is the appropriate code to report. Using a digital recorder alone does not qualify the test for submission of 95957. Most run EEGs on digital machines, but using a digital recorder alone does not qualify the test for submission of 95957. True "digital" analysis, as described by 95957, requires that the neurologist or technologist conduct the analysis using quantitative analytical techniques such as data selection, quantitative software processing, and dipole source analysis. This kind of analysis generally entails additional work by the neurologist or technician (up to an hour or more) to process the data from the digital EEG, as well as an extra 15-45 minutes of physician time to review the data. Digital recording uses a digital EEG recorder but is digital only to the extent that the neurologist doesn't use an analog paper recorder at the time of wave-form capture. This represents a typical EEG interpretation in most clinical situations, and you should report this using only the appropriate EEG code.


 


You must provide medical necessity to report 95957, and the physician must supply evidence to demonstrate that the results will affect patient management directly.  


 


Digital analysis of the EEG results will enhance the clinician's ability to identify abnormal spikes, rhythmic discharges, epileptiform activity and localization of discharges. "The digital analysis will also distinguish seizures from pseudo-seizures and determine the types of seizures - which ultimately will have a profound effect in the selection of antiepileptic medications."


 


BX-Texas has a policy on this: http://medicalpolicy.hcsc.net/medicalpolicy/home?ctype=POLICY&cat=Medicine&path=/templatedata/medpolicies/POLICY/data/MEDICINE/MED205.008_2010-03-01#hlink

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