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Guidelines to Codes and Billing

Rationale:

This document serves to provide guidelines for the correct usage of Clinical Technology codes in the field of Neurophysiology.These are guidelines only, in line with acceptable practice. Variations might exist, and should be supported by written request from a referring medical practitioner. 

General:

    • All tests and procedures should be performed on written request from a referring medical practitioner.
    • The referring medical practitioner’s details (name and practice number) should appear on all claims.
    • Nappi codes used for disposables should be the same as reflected on supplier of product’s invoice.
    • Split-billing is not permissible. Additional amounts charged should reflect on each invoice (balanced-billing).

Difference between balanced-billing and split-billing: 

      • Balanced-billing is when the service provider sends two identical accounts to both the patient and the scheme indicating the full amount for the services delivered, but specifying the portion owed by the patient and the portion of benefits the medical scheme is prepared to pay for the service rendered.
      • Split-billing occurs when the service provider sends two separate accounts, one to the patient and one to the medical scheme, that presents different amounts for the same service. In other words, the account to the patient only reflects the amount that the patient is responsible for, while the claim to the medical scheme only reflects the amount equal to the benefits the medical scheme is prepared to pay for the service rendered.
      • Therefore, balanced billing on one account, as opposed to split billing on separate accounts, is perfectly admissible.

    Back-up: 

    Backed-up copies of test results / graphs / referral letters / patient notes should be kept in line with Booklet 14: Guidelines on the keeping of patient records, from the ethical guidelines from the Health Professions Council of South Africa.

    This document may be updated from time to time by Exco of CNSSA

    Section 1: EEG: 

    Abbreviations:

    EEG:               Electro-encephalography
    HV:                 Hyperventilation
    PS:                  Intermittent photic stimulation

     

    Routine EEG in rooms, minimum 20 minutes, maximum 30 minutes, including HV and PS:
    75133 Routine EEG with special activation 

    Routine EEG in rooms, minimum 30 minutes, maximum 60 minutes, including HV and PS, extended to include sleep (sedated, deprived or natural) on doctor’s orders:
    75133 Routine EEG with special activation, minimum 20 minutes
    75119 Sleep EEG, exceeding 30 minutes 

    Routine EEG in hospital (Ward, ICU, high care), minimum 20 minutes, maximum 30 minutes, including HV and PS:
    75133 EEG with special activation
    75132 Setup of Mobile Neurophysiological Equipment, out of rooms. 

    Routine EEG in hospital (Ward, ICU, high care), minimum 30 minutes, maximum 60 minutes, including HV and PS, extended to include sleep (sedated, deprived or natural) on doctor’s orders:
    75133 EEG with special activation
    75132 Setup of Mobile Neurophysiological Equipment, out of rooms.
    75119 Sleep EEG, exceeding 30 minutes 

    Routine EEG on Neonate in Neonatal ICU, minimum 60 minutes, plus additional time:
    75133 EEG with special activation
    75132 Setup of Mobile Neurophysiological Equipment, out of rooms.
    75119 Sleep EEG, exceeding 30 minutes
    75139 Each additional hour or part thereof provided that such part comprises 50% or more of the time. 

    Extended EEG recording, in hospital, minimum 8 hours, maximum 16 hours:
    75187 Long term EEG monitoring with a minimum of 8 hours (but less than 16 hours) recording time, including preparation (collodion adhesive technique with at least 21 electrodes) and interpretation
    75132 Setup of Mobile Neurophysiological Equipment, out of rooms.
    75175 Collodion Adhesive (max 2 tubes) 

    Extended EEG recording, out of hospital, more than 16 hours, maximum 24 hours:
    75188 Long term EEG monitoring with 16 to 24 hours recording time, including preparation (collodion adhesive technique with at least 21 electrodes) and interpretation
    75175 Collodion Adhesive (max 2 tubes) 

    Extended EEG recording, in hospital, more than 16 hours, maximum 24 hours:
    75188 Long term EEG monitoring with 16 to 24 hours recording time, including preparation (collodion adhesive technique with at least 21 electrodes) and interpretation
    75175 Collodion Adhesive (max 2 tubes)
    75132 Setup of Mobile Neurophysiological Equipment, out of rooms.

    Video and EEG Epilepsy Monitoring in Specialized Unit:
    75188 Long term EEG monitoring with 16 to 24 hours recording time, including preparation (Collodion adhesive technique with at least 21 electrodes) and interpretation
    75175 Collodion Adhesive (max 2 tubes) 

    – Per subsequent day:
    75188 Long term EEG monitoring with 16 to 24 hours recording time, including preparation (Collodion adhesive technique with at least 21 electrodes) and interpretation
    75175 Additional Collodion Adhesive (if needed max 2 tubes) 

    Intraoperative EEG Monitoring: (see above for intracranial ECoG)
    75133 EEG with special activation (Baseline)
    75132 Setup of Mobile Neurophysiological Equipment, out of rooms.
    75119 Sleep EEG
    75141 Intra-operative EEG (eg. carotid endarterectomy)
    75139 Each additional hour or part thereof provided that such part comprises 50% or more of the time

     

    Section 2: SLEEP:

    Obstructive Sleep Apnea Screening, one night, no EEG, minimum 6 channels:
    75186 Obstructive sleep apnea screening

    Full overnight Polysomnogram, one night:
    75185 Overnight Polysomnography
    75175 Collodion Adhesive (max 1 tube)

    Overnight CPAP Titration, one night:
    75186 Obstructive sleep apnea screening
    75127 Overnight CPAP Titration
    75153 CPAP training and problem-solving

    Multiple Sleep Latency Test, preceded by Full Overnight Polysomnogram night before, minimum 4 sessions:
    75125 Multiple Sleep Latency Test
    75175 Collodion Adhesive (max 1 tube) 

    COMBINED POLYSOMNOGRAM AND EEG

    Note: Please be advised that a polysomnogram and prolonged EEG [16-24 Hrs.] can sometimes be requested at same time. Note that these are two separate procedures and separate interpretation for diagnosis or differential diagnosis of epilepsy and sleep disorders.  Two ICD 10 codes, one for each procedure should be provided. 

    Section 3: EMG/NCS:

    Billing per nerve / muscle tested, to a maximum of 10:
    75135 Nerve conduction studies (motor and/or sensory) each, per nerve (Specify nerves on account if medical schemes would not reject this as duplicate claim)
    75135 Electromyography [needle EMG], per muscle (Specify muscles on account if medical schemes would not reject this as duplicate claim)
    75115 Additional 2 nerves (used as adjunct with nerve conduction studies, including F-waves, H-reflexes or additional nerves required for diagnosis)
    75132 Setup of Mobile Neurophysiological Equipment, out of rooms. (When appropriate) 

    Notes:

    – Electromyography [EMG] and nerve conduction studies are two separate procedures most frequently performed together.

    – In some cases, bilateral upper and / or lower limb somatosensory evoked potentials may be performed with an EMG/NCS to document additional pathology in spinal cord or brain.
    75175 Concentric or monopolar EMG Needle (with appropriate Nappi Code) 

    Section 4: Evoked Potentials:

    ABR:
    75178 Short latency brainstem auditory evoked potentials, neurological evaluation, bilateral
    75179 Auditory evoked potentials. Full audiological examination, bilateral 
    75183 Electronystagmography (ENG) for spontaneous & positional nystagmus
    75184 Caloric test done with electronystagmography (ENG)

    VEP:
    75180 Pattern-reversal visual evoked potentials: full evaluation of visual pathways, unilateral (charge x2 for bilateral)
    75180 Pattern-reversal visual evoked potentials: full evaluation of visual pathways per check size [16’ or 32’] unilateral [Maximum 2 check sizes]

    ERG:
    75117 Electroretinography (ERG) – unilateral or Electro-oculography (EOG) (X2 for bilateral)

    SEP:

    Upper limb SEP:
    75181 Somatosensory evoked potentials, unilateral, upper limb (X2 for bilateral)

    Lower Limb:
    75182 Somatosensory evoked potentials, unilateral, lower limb (X2 for bilateral) 

    Section 5: Transcranial Doppler Studies:

    Note: Transcranial Doppler studies can be billed twice daily in respect of monitoring in certain conditions like vasospasm after sub-arachnoid hemorrhage or head injury. 
    75143 Transcranial Doppler bilateral 
    75093 Added if color imaging is used
    75031 Determination of cerebral hemodynamics. [Can only be charged once daily] 

    Section 6: Heated, Humidified High Flow Oxygen therapy:

    Clinical Indication: To be requested by Physician and clinical technologist may be asked to assist in the titration phase. Correct indications are:

    Hypoxic respiratory failure, e.g.:

    • Community-acquired pneumonia
    • Viral pneumonia (e.g. influenza)
    • Acute asthma
    • Cardiogenic pulmonary oedema
    • Pulmonary embolism
    • Interstitial pneumonia
    • Carbon monoxide poisoning

    Need for high FiO2 oxygen delivery in settings such as:

    • Intubation (pre-oxygenation and apnoeic oxygenation)
    • Post – extubation respiratory distress
    • Do-not-intubate/ palliative settings
    • Post – cardiac surgery
    • Oxygen supply during invasive procedures, e.g. BAL, TOE, upper GI endoscopy

     

    The patient needs titration of optimized FiO2 and flow rate by:
    75031 Determination of haemodynamic or pulmonary parameters.

    [This code is billed per day as the clinical technologist is involved with titration and weaning of the high flow device.]
    75127 CPAP Titration (Appropriate to charge 1X)

    Notes:

    • As this is a new procedure it was decided by the working group to use the 75031 code instead of the 75186 Obstructive sleep apnea screening code to monitor the respiratory and haemodynamic parameters]
    • Code 75186 Obstructive sleep apnea screening may have been used previously to monitor respiratory and SpO2 parameters during the titration process but it was agreed upon to replace this code with 75031.
    • The clinical Technologist should discuss the billing of 75031 with the managing medical specialist. If the specialist billed codes 1212, 1213, 1214, 2724, then the clinical technologist may not bill.
    • The management of the high flow device should be discussed between the practitioners involved. 

    Section 7: Intra-operative Neuro-monitoring (IONM):

    – Varies per procedure and neurological structures monitored

    – Multi-Modality Evoked Potentials, include upper and/or lower SEP, ABR [Neurological], Motor evoked potentials [no code exist currently for this modality], Flash VEP as well as free-running EMG [charged per muscle group monitored]

    Current: 

    75*** Charge for actual nerve / muscle / neural structure monitored (Baseline)
    75137 First Hour
    75139 Subsequent Hours
    75132 Setup of Mobile Neurophysiological Equipment, out of rooms.