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Pain Management Billing and Coding: Common Mistakes and Challenges

November 28, 2018

Pain Management Billing

There’s significant room for growth for pain management centers today, especially since the American Academy of Pain Medicine estimates that more than 100 million Americans are affected by chronic pain, which is far more than the number of patients affected by heart disease, diabetes, and cancer combined. While there’s potential for growth, some of the pain management billing and coding challenges make it difficult to thrive. Successful billing and coding is half the battle when you’re trying to increase practice revenue. Avoid common billing and coding mistakes to make sure your pain management practice is poised to grow and thrive in 2019.

Avoid Billing Procedures Based Solely on Summaries 

One of the big mistakes in pain management billing and coding is to bill a procedure based only upon a summary. According to Medicare, you are only permitted to bill for any procedures that have been documented in the body of a report. This means that coders must look beyond the summary that’s at the beginning of the report for coding purposes.

Ensure Errors in Medical Records are Properly Corrected

Since meeting documentation requirements is critical to ensuring that payers actually pay for services, dealing with errors in medical records appropriately is crucial. Physicians should never scratch out words or use correction fluid within patient records. If there’s an error in a patient’s records, the error should have a single line drawn through it in ink, the word “error” should be written above it, and the correction should be made. It is also essential for physicians to initial the correction made in the records.

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Look Out for “Canned” Reports 

For certain procedures, sometimes physicians used “canned” reports or report templates instead of creating a report that’s tailored to the specific patient and pain management procedure. Unfortunately, these templates may not contain all the essential information for proper documentation. In some cases, the report may not provide information on the exact procedures performed or indicate upon which side a procedure was done.

Examine and Verify Codes Listed in Reports 

Another costly pain management billing and coding mistake is to simply list codes provided by physicians in reports. Proper coding involves examining those reports and making sure that codes effectively and accurately reflect services provided by the physician. It’s also essential to verify that adequate documentation has been provided for procedures being coded.

Billing Fluoroscopy in Pain Management Often Results in Errors 

One of the common errors in pain management billing and coding is billing fluoroscopy separately. Fluoroscopy is actually included in many pain management codes, such as discography, intraarticular joint or medial branch block facet joint procedures, transforaminal epidural steroid injections, and radiofrequency ablations. Billing fluoroscopy separately often results in duplicate claims made for a single procedure, which leads to costly denials that affect your bottom line.

Don’t Forget About Modifier -50

When coding for bilateral procedures, always be sure to include modifier -50. This modifier provides extra information regarding the procedure being coded. Modifier -50 specifically represents a procedure or service that’s performed on both sides of the patient’s body during one session. Unfortunately, it’s a common mistake to forget modifier -50 or merely code each side of the body separately.

Continuing Changes Result in More Challenges for Pain Management 

Pain management reimbursement continues to changes regularly, and the documentation procedures you have used in the past may now start resulting in denials. Payers are requiring more documentation and more specific documentation. Pain management codes keep changing as well. Along with policy and coding changes, your practice’s coding staff has to stay on top of these changes and update your own procedures to each payer’s requirements. Unfortunately, all the changes can result in challenges keeping the revenue cycle moving for your practice.

For many pain management practices, outsourcing to a professional medical billing and coding company helps solve this problem. At M-Scribe, we have extensive experience with pain management billing and coding, and we work with pain management centers across the country. Along with offering you a billing and coding solution, we provide contracting services, too. Contact M-Scribe today to learn how we can help you increase revenue for your pain management practice.


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