Stand by: Long-Duration EEG Recording and Monitoring Codes are Still Under Review

Simon and Mary Anne Griffin, CEO and COO of Lifelines, participated in the February AMA CPT Editorial Panel meeting held Feb. 8 in San Diego. Along with other leaders in the neurodiagnostic community, the Griffins attended, helping to shape the discussion regarding potential changes in the coding.

The submitted coding proposals were discussed at great length, but it was agreed there was still work to do to correctly structure the language in the code.

“The primary concern is ensuring the wording for long-duration EEG recording and monitoring correctly represents the care that is provided, whether it is in a hospital, clinic or ambulatory, home setting,” says Simon Griffin. “The CPT Editorial Panel’s duty is not to determine reimbursement. It all comes down to correctly describing the quality of care and oversight that is provided during these EEG studies.”

While the panel meeting proceedings are confidential, there are signals coming from payors today that the ability to document interventions while monitoring patients is becoming critically important. Maintaining an audit trail that proves a facility has the ability to intervene in a study will likely become standard. Solutions like the Lifelines iEEG Cloud are aligned with this change.

The current coding proposal is scheduled to be resubmitted in early March and should be made available for public viewing in late March. The new submission will hopefully be considered and placed for panel approval at the next CPT Editorial Panel meeting in San Antonio on May 17-19, 2018. Final changes to the CPT codes are not expected to go into effect until 2020 at the earliest.

What can you do? Let your voice be heard.

The meeting agenda will be posted on the AMA website on March 16 and the deadline to request to review these code change applications is April 26. The deadline for submission of written comments is May 3. To view the agenda, register to attend the meeting or provide comments, click here.

When applying for an application to attend the panel meeting or submitting written comments for consideration, please remember the CPT Editorial Panel is not responsible for reimbursement. Their focus is on ensuring that the CPT wording accurately describes the quality and oversight of care provided. When applying to be part of this process, expressing concerns about reimbursement, rather than interest in the neurodiagnostic studies and patient care, will not likely be granted approval.

In the meantime, some insurers have been downgrading the reimbursement for long-duration EEG studies, demanding repayments from providers, some in six-figure range. Providers are encouraged to get pre-approval for studies, as well as to document interventions. This will ensure advanced preparation for any upcoming changes to the coding.

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