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Best Practices for Pain Management Billing and 2019 Coding Changes

September 25, 2018

Pain Management Billing and 2019 Coding Changes

Billing and coding for pain management practices continues to grow more complicated each year. With increased public and medical interest in new pain management techniques, pain management guidelines, and new therapies, there’s very close scrutiny by payers and regulators on procedures used to treat chronic pain. Not only is it essential to handle pain management billing and coding carefully to prevent denials and audits, but quality billing and coding is also crucial to the financial well-being of the practice. Here’s a closer look at some of the best practices for pain management billing and coding to help you keep your practice healthy financially. 

Know the Common Codes and Modifiers Used in Pain Management 

First, it’s important to know the most common codes and modifiers used in pain management, and since there are coding changes every year, it’s essential to stay up-to-date on those changes. Some of the most commonly used pain management billing codes include: 

  • 20610 – major joint/bursa – injection or aspiration of the pes anserine bursa, subacromial bursa, hip, trochanteric bursa, shoulder, or knee
  • 77002 – Fluoroscopic needle guidance (non-spinal)
  • 20552 – Trigger point injection in one or two muscles
  • 96372 – Intramuscular injections
  • 64405 – Greater occipital nerve block
  • J0585 – Botulinum toxin type A injection 
  • 20526 – Carpal tunnel injection
  • 97010 – Cold packs/heating pads
  • G0283 – Transcutaneous Electrical Nerve Stimulation 

Knowing your modifiers for pain management coding is also important, and a few modifiers to remember include: 

  • -LT – left anatomically 
  • -RT – right anatomically
  • -50 – bilateral
  • -59 – notes that a service or procedure is independent and separate from other services that were performed on that same day
  • -52 – incomplete procedure – stopping part of the procedure due to reasons other than patient well-being
  • -53 – incomplete procedure – the physician chooses to end a procedure for the patient’s well-being. 

Related Article:  Overcoming Pain Management Billing Challenges

Be Descriptive with Diagnosis Descriptions

Another critical practice for pain management billing and coding is to be as descriptive as you can with diagnosis descriptions. It’s important to include not only the condition, but also the cause, the site, and laterality. The description should also include a qualifier as well as any special details, such as without/with bleeding/obstruction, hemorrhage as applicable for the services performed. Descriptive diagnosis descriptions are more important than ever with ICD-10 and can help prevent denials.

Tips for Documenting Injections Appropriately 

Injections like facet joint injections, trigger point injections, and nerve blocks require a significant amount of documentation, particularly when multiple levels are involved. It’s important to have the right information on hand when preparing these claims. Some of the information that you need to include to make sure you avoid costly delays and receive full reimbursement for injections include: 

  • Spinal levels involved in the injection
  • Route the needle took and the final position of the needle used
  • Whether any fluoroscopic guidance was used in the procedure
  • Diagnoses supporting the procedure
  • The specific medication that was injected
  • For trigger point injections, all muscles injected must be documented, as well as laterality (coding depends on the number of muscles injected)

Changes in the 2019 Fee Schedule Affecting Pain Management Billing

This past July, the Centers for Medicare and Medicaid Services released their proposed physician fee schedule for the coming year. Along with the physician fee schedule, it also contains provisions for the 2019 Quality Payment Program. Some of the changes in the proposed 2019 physician fee schedule that affect pain management practices include: 

  • Some decreases for codes regarding occipital nerve blocks, electronic analysis of programmable pump, and suprascapular nerve blocks 
  • Increases for the placement of spinal cord neuro-electrodes
  • Hip joint injection increases

Benefits of Outsourcing Pain Management Billing and Coding 

Because pain management billing and coding is so complex and constantly changing, many practices find that outsourcing their billing and coding save time and money. With a quality billing and coding company, practices often see revenue increases and higher net collections. Just a few of the benefits your pain management practice can enjoy when you choose to outsource include increased collections, more complete and more accurate coding, fewer days in accounts receivable, lower denial rates, and lower fixed costs. This option also allows you to do what you do best – focus on medicine – instead of worrying about back office tasks. 

Pain Management Billing Coding Changes in the Year 2020

M-Scribe offers billing and coding services to practices across the country, and we work with you to make sure we can meet your unique pain management billing and coding needs. Whether your practice is experiencing high denial rates, trying to improve revenue, or you simply want to spend more time focusing on your patients, M-Scribe can help. Contact us today to learn more about our billing and coding services and how we can help your pain management practice thrive.


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