Neurology practices frequently encounter claim denials for long-term electroencephalogram (EEG) monitoring (such as CPT codes 95700–95726) due to strict Local Coverage Determinations (LCDs) regarding medical necessity and missing clinical indication documentation.
One huge angle folks overlook is step therapy requirements! 
Payers often auto-deny 95700–95726 if there’s no documented trial of standard routine EEGs or failed conservative meds first. 
Always make sure your billers link previous negative or inconclusive routine EEG dates right in the initial prior authorization notes to prove medical necessity upfront! 
Don’t forget technical billing setup errors! Many automated payer systems trigger medical necessity denials if the continuous setup code (CPT 95700) isn’t billed on the exact start date, or if monitoring duration codes don’t match the tech log hours. 
Pre-scrubbing technical setup dates against monitoring logs stops these automated denials before claims even go out! 
Another huge cause of EEG denials that often gets overlooked is symptom coding versus definitive diagnosis coding.
Payers love to deny long-term monitoring when providers list generic ICD-10 codes like dizziness or transient altered mental status without supporting neurological context. If the provider hasn’t established an active seizure disorder yet, billing services need to make sure the primary diagnosis code reflects specific, high-risk clinical events. For instance, using focal neurological deficits or suspected non-convulsive status epilepticus instead of a basic headache code makes a massive difference.
Training your clinical staff to document specific spell descriptors in the encounter notes keeps medical necessity clean before billing.
Hey folks! Another sneaky issue to watch out for is electrode placement duration tracking errors tied to commercial payer automated rules. 
If your telemetry logs don’t clearly separate hook-up times from actual recording intervals, algorithms flag them instantly. Getting your tech team to sync exact time stamps prevents these headaches before claims even drop.