Visits, diagnostic testing and drugs on one claim stream
A neurology practice bills complex office visits alongside diagnostic testing — EEG, EMG and nerve conduction, sometimes sleep studies — and injectable or infused drugs. Each has a different coding logic: visits by medical decision-making or time, tests by duration, number of studies and who owns the equipment, and drugs by billing units. Many of the most valuable services also need medical-necessity documentation or prior authorization.
EEG and long-term monitoring
Routine EEGs (95812–95822) are coded by recording length and state (awake, drowsy, asleep). Long-term and video EEG monitoring (95700–95726) is split into separate codes for setup, technologist monitoring per recording period and the physician’s review and report, which depend on duration and on whether video was recorded. Each part has to be documented with times, and the professional and technical work may be billed by different parties.
EMG and nerve conduction studies
| Test | How it is coded | Codes |
|---|---|---|
| Nerve conduction studies | Total number of nerve studies (motor, sensory and F-wave) performed | 95907–95913 |
| Needle EMG with nerve conduction | Add-on per extremity (complete or limited) | 95885, 95886, 95887 |
| Needle EMG alone | Number of extremities or region | 95860–95872 |
Payers — including Medicare contractors through local coverage determinations — set medical-necessity rules for electrodiagnostic testing, limits on the number of studies per diagnosis and qualifications for the person performing the test. Counting studies correctly and linking them to a supporting diagnosis prevents most denials.
Botulinum toxin and other drugs
- Chemodenervation is coded by indication and site, such as 64615 for chronic migraine, with the drug billed separately by HCPCS code and units.
- Wastage: for single-dose vials, Medicare requires modifier JW on any discarded amount and JZ when none was discarded; the note records dose given and amount wasted.
- Authorization: botulinum toxin, CGRP therapies, multiple sclerosis disease-modifying drugs and infusions usually require prior authorization and renewals.
Sleep studies and testing components
In-lab polysomnography (95810, 95811) and home sleep testing (95800, 95806 or Medicare’s G0398–G0400) have their own coverage criteria. When a neurologist interprets a test performed on another organization’s equipment, only the professional component (modifier 26) is billed; owning the equipment allows the technical component (TC) or the global service. See prior authorization services for specialty-drug approvals.