Some things to think about if your EEG lab offers Ambulatory testing…

With the new Long Term Video EEG monitoring coding guidelines going into effect in 2020 EEG labs now have 3 different levels of testing to offer:

1 – Monitored
2 – Intermittently Monitored
3 – and Un-Monitored

The Un-Monitored option is the one that is most like the current model of Ambulatory VEEG monitoring – patient is set up in the lab, patient goes home with the recording, patient returns to the lab after 1, 2 or 3 days, and then the data is reviewed in a timely manner and a Physician report is generated.

This option is still available with the following new codes:

95700 – Set Up Charge (1 per test)
95714 – times the Number of Days (Technical Charge)
95720 – Professional Reading code for a 24 hour
95722 – Professional Reading code for a 48 hour
95724 – Professional Reading code for a 72 hour

However; if a lab would like to offer the next tier of monitoring for their Ambulatory studies and meet the Intermittent Monitoring guidelines, some new (and challenging) processes would need to be put in place.

The Intermittent Monitoring requires a technician to view the data live for 10 minutes every 2 hours. It also requires the Physician to review each day’s recording and place a report in the patient’s electronic medical record before each 24 hours is complete.

This creates a whole host of challenges when converting from how Ambulatory studies have typically been done to the new Intermittent Monitoring.

What does Intermittent Monitoring look like:
1 – First, you have to be sure you have a system that allows for remote monitoring (many EEG labs would need to purchase new equipment).
2 – An Ambulatory Day would be set – for example, 2pm – 2pm
3 – The technician on-call would contact the patient 2 hours after the recording starts to plug the head box into the remote recording device (most likely a tablet); then the technician logs on to view for at least 10 min and then the patient unplugs the head box.
4 – Repeat every 2 hours.
5 – At bedtime instruct the patient to plug the head box in and leave it plugged in until they wake up.
6 – 2 hours prior to the end of the daily recording a REEGT technologist would log on and upload the study to prune it for the physician or the physician would review the entire day after a technician uploads it.
7 – The physician generates a report for the medical record before 2pm
8 – Repeat all steps again for a 48 hour study or repeat two more times for a 72 hour study.

What do EEG Labs need to have in place to do Intermittent Monitoring:
1 – They need to own equipment that has remote viewing capabilities.
2 – Devices need to have an Internet Plan and a paid remote viewing software plan like TeamViewer installed (personal plans are free but business plans require paid plans).
3 – A technician call rotation should be established.
4 – Determine which physician is going to read and report on the daily monitoring (an on-call doctor or the referring doctor).
5 – On call pay, Night differential, Weekend differential for technical staff should be set if it is not already in place.

As you can see this is a big difference for how this test has typically been done…whether it is worth it to make this jump in cost and staffing is up to each lab (not to mention the inconvenience to our patients that are already sometimes challenged just to change batteries and keep themselves on camera).

If you choose to do Intermittent Monitoring, this is what your codes would look like:
95700 – Set Up Charge (1 per test)
95715 – times the Number of Days (Technical Charge)
97720 – times the Number of Days (Professional Reading code)

For the third level of codes – Monitored (Continuously at a 1 – 4 tech to patient ratio)….these are not intended for Ambulatory studies. These codes logically would be used for inpatient hospital monitoring units.

Would love to hear how your lab is adjusting to the new codes!
Comment below or send me an email @ RTompkins@TompkinsAssociates.com