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CPT Coding for Pain Management(1)

CPT Coding for Pain Management(1)

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CPT coding for pain management is really a hectic task and outsourcing it to a reliable medical coding company helps you earn more while focusing on your core processes
CPT coding for pain management is really a hectic task and outsourcing it to a reliable medical coding company helps you earn more while focusing on your core processes

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Published by: Outsource Strategies International on Aug 30, 2013
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Summary: CPT coding for pain management is really a hectic task and outsourcing it to a reliable medical coding company

helps you earn more while focusing on your core processes. CPT Coding for Pain Management Pain management professionals are busy healthcare practitioners as their area of practice is vast and the patients belong to diverse age groups. The types and levels of pain is yet another factor, varying from neoplasm-related pain, spinal pain, acute, chronic to post-surgical pain. This article discusses some important CPT codes that will be useful for diverse pain management professionals including medical practitioners, clinical psychologists, physiotherapists, nurse practitioners, occupational therapists, and clinical nurse specialists. CPT coding for pain management is difficult and requires considerable knowledge on the part of the medical coder who carries out the task in-house. It is easier to entrust the job to a medical coding company that can offer the service of trained, professional medical coders and billers. Commonly Used CPT Codes Joints and Bursa – Injection or Aspiration

Major joint/bursa: 20610 (Arthrocentesis, aspiration and/or injection; major joint or burse(knee, hip, shoulder, trochanteric bursa, subacromial bursa, pes anserine bursa) This does not include the injectable drug which should be billed separately with the appropriate J code Fluoroscopic needle guidance (non-spinal): 77002

Tendons, Ligaments, and Muscle Injections

Tendon origin/insertion: single 20551 Trigger point injection (3 or more muscles): 20553

Nerve Blocks

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Greater occipital nerve block Injection- anesthetic agent: 64405 Intercostal nerve (single) Injection, anesthetic agent: 64420

Epidural Steroid Injections (ESI) • • Interlaminar – cervical or thoracic: 62310 Transforaminal – cervical or thoracic (first level): 64479

Facet Joint Procedures • • Intraarticular joint or medial branch block (MBB) – cervical or thoracic (1st level or site): 64490 Intraarticular joint or medial branch block (MBB) – lumbar or sacral (3rd level or site): 64495

Radiofrequency Ablation (RFA) / “Destruction” of Facet Joint • • Radiofrequency ablation (RFA) – cervical or thoracic (1st joint): 64633 Radiofrequency ablation (RFA) – lumbar or sacral (each additional joint): 64636

Sacroiliac Joint • • Sacroiliac joint (SIJ) with fluoroscopy: 27096 Sacral lateral branch blocks: 64450

Vertebroplasty • • Vertebroplasty – Thoracic (1st level): 22520 Vertebroplasty – Lumbar (each additional level): 22522

Kyphoplasty • • Kyphoplasty – Thoracic (1st level): 22523 Kyphoplasty – Lumbar (each additional level): 22525

CPT Coding Changes 2013 Revised Codes

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76942- Ultrasonic guidance for needle placement, (e.g. biopsy, aspiration, injection, localization device), imaging supervision and interpretation 64612- Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (e.g. for blepharospasm, hemifacial spasm 64561- Percutaneous implantation of neurostimulator electrode array: sacral nerve (transforaminal placement), including image guidance, if performed 64614- Chemodenervation of muscle(s); extremity and/or trunk muscle(s) (e.g. for dystonia, cerebral palsy, multiple sclerosis

New Codes

64615- Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (e.g. for chronic migraine) +95940 - Continuous IONM in the OR one on one monitoring requiring personal attendance, each 15 minutes

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95907-95913- Nerve conduction tests studies new codes in 2013 are used to reflect number of studies performed, rather than each nerve, as the unit of service. +95941 - Continuous IONM, from outside the OR (remote or nearby) or for monitoring of > 1 case while in the OR, per hour

Deleted Codes • • 95900, 95903 and 95904- nerve conduction tests codes +95920- Intraoperative neurophysiology

Highlights of CPT Coding Updates

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None of the anesthesia codes were added, deleted, or revised for 2013. CPT 2013 defines time for all time-based codes. These are codes the selection of which depends on the amount of time required to perform the service. “Time is the face-to-face time with the patient” unless other specific instructions are contained in the code or code range instructions. A unit of time coincides with the passing of the midpoint. In case a different service is performed side by side with a time-based service, the time required for the concurrent service cannot be included in the time used to report the time-based service. A complete rewrite of the Medicine-Psychiatric Services section is made in CPT 2013 including revised codes, 11 new codes, and 27 deletions. Parenthetical note for code 76942, imaging supervision, interpretation and ultrasound guidance for needle placement has changed. The term “Qualified Healthcare Professional” (QHP), and its usability has been introduced. Distinct from “clinical staff,” a “physician or other qualified healthcare professional” refers to an individual who is qualified by education, licensure/regulation, training and facility privileging (when applicable), who performs a professional service within her/his scope of practice and independently reports that service. “Clinical staff” cannot individually report a professional service that he/she has assisted in.

Some Rules for Pain Management Coding

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To report postoperative pain management, CPT codes 62310-62319 shouldn’t be used if a narcotic or other analgesic and anesthetic agent are injected postoperatively through the same catheter. CPT codes 64615 and 64614 can be reported only once per session. Modifier 50 is to be reported for performing bilateral procedures.

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The billing could be separately done if the surgeon is assisted by the anesthesiologist by performing an epidural or peripheral nerve block injection for postoperative pain management. Modifier 52 is to be reported for an incomplete procedure.

Merits of Outsourcing Pain Management Coding Instead of carrying out the heavy task of pain management coding in-house, you could benefit a lot by outsourcing the task to a reliable medical coding and billing company. Benefits include: • • Regular follow-up with insurance companies Enhanced cash flow and better collections HIPAA compliant medical coding services Efficient management of the claim denial process Improved patient satisfaction Minimal chance of under coding and over coding Focus more on your medical practice

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About Outsource Strategies International Outsource Strategies International (OSI) is a HIPAA Compliant medical coding company that provides medical coding outsourcing services to physicians, billing companies, and individual doctors. The company utilizes advanced software such as EncoderPro,FLashcode and CodeLink to facilitate speedy medical insurance billing and coding. For more information visit http://www.outsourcestrategies.com/

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