Transmission of the EEG by telephone, radio, or cable is considered medically necessary when the closest medical facilities are located in remote areas which lack trained EEG interpreters for patients with the following indications:

• Altered consciousness, such as stuporous, semicomatose, or comatose states (780.09);
• Atypical seizure variants in patients experiencing bizarre, distressing symptoms as seen with "spike and wave stupor" or other forms of seizure disorders;
• Head injury, where a subdural hematoma may be identified (852.2-852.29); or
• Differentiation of complicated migraine with epilepsy-like symptoms (e.g., auras, alterations in level of consciousness) from true seizure disorders.

Telephone transmission of the EEG to determine electrocerebral silence, i.e., brain death, is considered experimental/investigational. Scientific evidence does not demonstrate the efficacy of telephonically transmitted EEGs in determining brain death.

Radio and cable telemetry of the EEG is considered medically necessary with prior approval for an:

• EEG recording during provocation testing (e.g., withdrawal of anticonvulsant medications), which can be safely undertaken only in the immediate proximity of emergency medical personnel and technology; and
• EEG recording attempting to localize the seizure focus prior to surgery when ambulation is desirable (e.g., when seizures are triggered by specific environmental stimuli or daily events).

Twenty-four hour ambulatory cassette-recorded EEGs are medically necessary with prior approval in the following circumstances:

• When used in conjunction with ambulatory electrocardiogram (ECG) recordings for seizures suspected to be of cardiogenic origin;
• When used in conjunction with electro-oculogram (EOG) and electromyogram (EMG) recordings for suspected seizures of sleep disturbances;
• When used for quantification of seizures in patients who experience frequent absence seizures; and
• When used in documenting seizures which are precipitated by naturally occurring cyclic events or environmental stimuli which are not reproducible in the hospital or clinic setting.

Scientific evidence does not demonstrate the efficacy of twenty-four hour ambulatory cassette-recorded EEGs in certain instances. Twenty-four hour ambulatory cassette-recorded EEGs are considered experimental/investigational in the following circumstances:

• For the study of neonates or unattended, noncooperative patients;
• In localization of seizure focus/foci when the seizure symptoms and/or other EEG recordings indicate the presence of bilateral foci or rapid generalization; and
• For final evaluation of patients who are being considered as candidates for resective surgery.

Video/EEG monitoring is considered medically necessary with prior approval when used to confirm the diagnosis of cases of complex seizures where treatment is defined by the seizure type. EEG video monitoring is useful for patients where a diagnosis could not be made on the basis of a neurological examination, routine EEG reporting, and ambulatory cassette EEG monitoring.

Description

An electroencephalogram (EEG) is a recording of the electrical current potentials spontaneously from nerve cells in the brain onto the skull. Variations in wave characteristics correlate with neurological conditions and are used to diagnose conditions.

EEGs can be transmitted by telephone in which electrical brain activity is recorded and transmitted to an off-site center for interpretation and report or by radio or cable in the diagnosis of complex seizure variants which require inpatient monitoring, but do not require the patient to be in bed.

EEGs can be recorded by twenty-four hour ambulatory cassette. Twenty-four hour ambulatory cassette-recorded EEGs offer the ability to record the EEG on a long-term, outpatient basis. Electrodes for at least four recording channels are secured on the patient. The cassette recorder is attached to the patient's waist or on a shoulder harness. Recorded electrical activity is analyzed by playback through an audio amplifier system and video monitor.

Electroencephalographic video monitoring is the simultaneous recording of the EEG and video monitoring of patient behavior. This allows for the correlation of ictal and interictal electrical events with demonstrated or recorded seizure symptomology. This type of monitoring allows the patient's face or entire body to be displaced on a video screen.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.