June 2023

Providers to receive denial for incorrect coding of electroencephalogram and ultrasound screening for abdominal aortic aneurysm, starting in September

What you need to know

Health care providers need to code correctly for electroencephalogram and abdominal aortic aneurysm screening to avoid a claim denial.

Electroencephalogram isn’t covered with a headache-only diagnosis. And the codes below shouldn’t be billed when the only diagnosis code on the claim is for headache or migraine. Beginning in September 2023, you may receive a denial when these codes are billed with a headache-only diagnoses:

*95812 — Electroencephalogram (EEG) extended monitoring; 41 to 60 minutes
*95813 — Electroencephalogram (EEG) extended monitoring; 61 to 119 minutes
*95816 — Electroencephalogram (EEG); including recording awake and drowsy
*95819 — Electroencephalogram (EEG); including recording awake and asleep
*95822 — Electroencephalogram (EEG); recording in coma or sleep only

Abdominal aortic aneurysm screening

Blue Cross Blue Shield of Michigan payment policy for abdominal aortic aneurysm screening study aligns with Centers for Medicare & Medicaid Services guidelines. Beginning in September 2023, you may receive a denial when an abdominal aortic aneurysm (CPT *76706) is billed for a male patient 65 years or older, but younger than 76, when a family history of abdominal aortic aneurysm or history of smoking isn’t present on the claim.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2022 American Medical Association. All rights reserved.