Frequently Asked Questions

 

Reimbursement Issues | Clinical/Practical Questions | Techincal Questions

 

Reimbursement Issues:

1. What CPT Codes are used?

95953 is the code for 24 hours of 16 or more channels of AEEG.  Medicare pays approximately $400 global fee with most labs billing upwards of $1200 per 24 hour period.  95951 is commonly used for 24 hour video telemetry when used in conjunction with the EEG.  Reimbursement is generally in the order of $1,600 for this procedure.

Please note that effective January 1st, 2011 the code 95956 has an updated description,  
“Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technologist or nurse”

This clearly eliminates it as a code for use with ambulatory EEG.

2. Can I get reimbursed for spike and seizure detection?

95957 is the code for digital analysis of the data.  Between $150 and $300 is the typical rate of return for this code.

Clinical / Practical Questions:

    1. What are the typical clinical indications for use?

As stated in the paper, Ambulatory EEG in the New Millennium

  • Documentation of seizure and seizure type, frequency and severity.
  • Documentation of sub-clinical seizures.
  • Differential diagnosis of seizure vs. syncope.
  • Differential diagnosis of seizure vs. pseudo seizure.
  • Differential diagnosis of seizure vs. behavior manifestations.
  • Differential diagnosis in Psychiatric Disorders.
  • Evaluation of efficacy of Anticonvulsant therapy.
  • Evaluation of efficacy of Ketogenic Diet therapy.
  • Pre-screening prior to removal from anticonvulsants.
  • Pre and post surgical screening of Vagal Nerve Stimulator™.
  • Pre and post surgical screening for epilepsy surgery.

 

2. Can you use electrode caps?

 

Caps are not recommended for AEEG.  They become very uncomfortable for long recordings and the electrodes move, creating problems.  Collodian applied electrodes is the recommended recording solution.

 

3. How many electrodes are needed to be applied?

16 channels of recording are the minimum used today in most labs.  In addition to these, the Trackit requires that you apply two additional electrodes, a reference and a neutral (ground) so in all there will be a minimum of 18 electrodes.

 

4. What type of electrodes does the system use?

 

Trackit uses standard 1.5mm touch-proof safety electrodes.  These can be purchased from any source.  Some brands, the yellow connector Grass electrodes for example, are too loose for practical purposes.

 

5. How should an adult wear the device?

 

The unit should be placed in the secure adult pouch and can either be worn using the thin shoulder strap (women like this), or attached to the patients belt using the loop on the pouch, or attached to the supplied waist and shoulder harness. The harness can be adjusted for fit and works best when worn like a crossing guard band! The electrode cover should be pulled over the electrode block. This can then be attached using the Velcro to the shoulder strap or the pouch. Some users even like to place the electrode block on the top of the head and wrap the connector into the head wrap bandage.  There are no fast rules about this, do what is most comfortable for each user.

 

6. How should a child wear the device?

 

The best solution is to use the specially designed backpack. The unit can be padlocked into the back pack to reduce tampering, yet the event buttons can still be accessed.

 

7. Can Trackit be used for PSG (Sleep Studies)?

 

Some models of the Trackit (T36, 24P, 12) are optimized for PSG applications as they include Bipolar inputs that can be used to record from transducers such as respiration belts. In addition Trackit can support O2 Saturation and a number of other non cephalic devices.  See the channel configuration guide for more information.

 

8. How do you review the data?

 

Trackit data can be read by a number of EEG reader packages.  The method of reading will depend on the package used with the system.  Usually, it takes about 20 minutes to review a 24 hour recording quickly.  Many labs will spend more time than this.

 

9. Do we have to review the data ourselves?

 

There are scanning services that charge approximately $200 per study that can review the data and produce a summary report.

 

10. Do we have to keep the complete record for archive purposes?

 

It is very common to sub sample the data and only keep the sections that contained interesting events, or abnormalities.  Programs like the Persyst Insight reader provide excellent archive tools that make this easy to accomplish.

 

11. How long does it take to download the data?

 

Trackit uses a removable flash card.  The data can be read by the PC as soon as the flash card has been placed in the card reader.  In this case there is no download time.  If you wish to transfer the file from the card to the PC, then the transfer time will depend on the speed of the hardware.  An external USB1 card reader takes about 20 minutes for a 24-hour recording.

Technical Questions:

    1. Why do you use removable media?

     

    Removable flash cards can be swapped very quickly allowing the Trackit to be put back into service quickly.  This makes the device more productive.  In addition, the system can be upgraded by simply purchasing a larger flash card.

     

    2. Aren’t flash cards unreliable?

     

    Mini hard disks were very unreliable for AEEG.  Unfortunately, some competitors have made poor implementation of flash cards and have reliability problems.  LifeLines has overcome all the main sources of unreliability.  Our users are accustomed to running AEEG’s every day without experiencing flash card problems.


    3. Can you use re-chargeable batteries?

     

    You can, but we don’t recommend them.  They cannot record anywhere near as long as the lithium batteries and over time they get even worse.  It would take 3 re-chargeable 9V batteries to run the Trackit for 24 hours.


    4. What reader packages can read Trackit data?

    The following are the prime readers:

  • Persyst Insight
  • Nervus Reader
  • Stellate Harmonie
  • Oxford Valor
  • Nihon Khoden
  • Viasys Nicolet nEEG reader
  • Neurotronics Polysmith
  • NCI Uniquant
  • Cleveland Clinic Vanguard
  • Grass

    Several other packages have been shown to work with the Trackit files with some limitations in the ability to read the Trackit event marks.

  • NPB Sandman
  • Compumedics Profusion

The data can also be read by some of the main research programs on the market

  • MatLab
  • EEG View
  • Many EDF viewers

 

5. What do existing users like about the system?

 

  • High quality of the recorded signal
  • The ability to run for 72-hours without changing battery or memory
  • Use of standard electrodes
  • The security of the unit, it is hard for a patient to tamper with it
  • The reliability of the device
  • The responsive support

 

6. How is the Trackit 2 different from the Trackit 1?

 

  • T2 is smaller and considerably less weight
  • T2 can record for longer on the same battery set
  • T2 has a brighter display
  • T2 has battery choice options
  • T2 uses off the shelf cables rather than proprietary cables
  • T2 can record on larger flash cards (< 2GB)

 

celebrating10yrs_blue

Lifelines Neurodiagnostic Systems, Inc. is proud to be celebrating its ten year anniversary