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Medical billing and coding for Pain Management practices can be complex.
Depending on your practice, you may need to bill for office services as well as ASC procedures and hospital visits and procedures. You What exactly is pain management and how is it billed? Pain management comes in many flavors. It ranges from an anesthesiologist performing pain management services part time to his or her anesthesia practice, all the way to a free standing multidisciplinary practice that may have physical therapy, neurology, surgery, radiology, and psychology providers as well as the pain management providers.
With several years of this developing specialty which includes coding/billing and A/R reconciliation, credentialing, we have the knowledge and expertise to handle every type of pain management issue that may arise. Coding for this specialty varies a good deal depending on the location and type of facility where the services are rendered. We have experience billing not only the Physician’s services, but the ASC services as well.
What we know…
Treatment of chronic or long-term pain can make billing hectic. Treatments would contain some or all of the following, medication, injections, such as epidural or trigger, stem cell or spinal injection therapies, psychological/ Cognitive therapy, and Chiropractic and bill procedures would be as follows:
Do not bill fluoro and drugs for major procedures.
Bill ultrasound and drugs for minor procedures (usually those done in the clinic)
Minor procedures are for instance: Major Joint Bursa, Pain Pumps, IM’s, trigger point injections, Greater Occ. Nerve, Intercostal, Stellate Ganglion
ABN – If pt signed an ABN, use GA modifier for procedure and drug
Procedures done outside of the Clinic or Fluoro Suite:
Do not bill the drugs, and use a 26 modifier on the Ultrasounds / Fluoro.
The following have Global Periods:
Spinal Cord Stimulator
Do not bill for Suture Removal
The most common mistake encountered in Pain Management coding is adding a CPT for needle guidance when it’s included in the injection CPT or not adding it when it’s not included. For example – fluoro guidance 77003 is included in 64483 Transforaminal epidural injection and cannot be billed separately. CPT 27093 Injection for hip arthrography does not include 77003 and it can be billed separately.
Another common mistake is billing bilateral injections as if they were done at two facet levels instead of using the modifier -50. For example – billing 64483 and 64484 instead of 64483-50.
On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases.
Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.
First Pass Clean Claim Rate
Boost in Revenue*
Reduction in Cost*
We’re always on top of all the latest coding and billing updates for Pain Management practices. Additionally, to make sure all claims are reimbursed on the first claim submission, our system is able to pre-edit claims prior to the initial submission for possible billing/coding errors. Our detailed end of month reports keep our clients up-to-date on what is happening in their practice so any issues can be addressed quickly. Having an experienced medical billing team, with visibility into performance, is vital to your practice’s financial health.
Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.
*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others
Service and Technology Packages
Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice
Silver RCM Service
This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.
Gold RCM Service
This package includes the core RCM services with added denials, A/R management services, and full service patient billing
Ancillary RCM Services & Technology
Available to enhance any package