Earlier this year, the Center for Medicare & Medicaid Services (CMS) made some big changes to the billing and reimbursement system for long-term EEG monitoring.
Techs and neurologists in this area went from needing to understand a handful of Current Procedural Terminology (CPT) codes to a mind-boggling 23 of them. The complexity of these codes and the documentation required have increased. The learning curve has been steep, and some fear the change will cause major damage to the industry.
We recently had the opportunity to speak with Kathryn Hansen, a neurodiagnostic technologist and coding expert, about these changes. Her view is considerably more optimistic – she sees these changes as an opportunity for technologists to become more empowered and thinks the industry will be better for it.
The new codes are outlined in the 2020 CPT Coding book released by the American Medical Association and officially went into effect in January 2020. Much has been written to explain the new codes, including these free resources from ASET the Neurodiagnostic Society, the American Academy of Neurology, and the Centers for Medicare and Medicaid Services, so we will only briefly explain them here.
CMS has deleted five Previously used CPT codes related to long-term EEG monitoring: 95827, 95950, 95951, 95953, and 95956. The codes that replace them are divided into two types — 10 to be used by neurologists and 13 to be used by neurodiagnostic technologists. Each code represents a different EEG study type based on study length, level of monitoring, and whether it includes video.
CMS introduced the new codes in an effort to curb costs and to qualify the medical necessity for these procedures.
“They wanted to validate what actually is the work required and the expertise required in practice today to perform these studies,” said Hansen in a recent interview.
Hansen (BS, R. EEG T., CPC, CPMA) has been in neurodiagnostics since 1966 and says it is not the first time she has seen changes like these. For example, more than a decade ago home sleep testing was introduced and many sleep centers felt like the ceiling on their industry was going to cave in.
But they pulled together, followed the new regulations, and improved clinical processes. The industry is now better for it.
“I have seen the best sleep medicine in the last decade. We work with less and we become smarter with what we have. I have never met a cut that didn’t result in better service pathways,” says Hansen.[The new EEG coding changes] is the same thing, except in neuro,” she adds. “You’ve got a revenue stream that is lower. You’ll have to be smarter with costs and with staffing, but it is doable. It’s very doable. We are a smart industry, if we want to be.”
Neurodiagnostic technologists have a choice: bury their heads in the sand or embrace the changes. To do this, she says, technologists need to play an active role in educating themselves so they can work in partnership with their billing departments.
“This requires an open dialogue and that takes training and education and knowledge on both sides,” Hansen says. “They all need to have some understanding of how the process works, too – from doing a study to submitting a billable charge and getting paid for it.”
Hansen urges all neurodiagnostic technologists to make use of the many resources available, like those mentioned above and this free ASET webinar.
“Change is hard. There’s no doubt about it,” she adds. “But we can look at this in a positive, empowering way. Let’s put our galoshes on and walk through the water to get to higher ground.”