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Pain Management Billing Coding Changes in the Year 2020

January 9, 2020

Pain Management Coding Changes 2020

Each year, CMS releases changes that practices across the country must familiarize themselves with or risk facing denials and revenue loss in the coming year. Becoming informed on the new policies and codes early can help set your practice up for success in 2020.  Although some specialties saw very few changes for 2020, there have been some significant changes that will affect the pain management specialty this year. From big changes to somatic nerve injection codes to the E/M coding changes coming in the future, here’s what you need to know. 

Significant Changes to Codes for Somatic Nerve Injections 

While quite a few specialties saw few to no changes in CPT codes, an entire family of codes used by pain management specialists and anesthesiologists saw some big changes for 2020. CPT codes 64400-64489 for Somatic Nerve Injections was the group of codes that got not only some deletions, but some revisions and additions, as well. 

New guidelines for this group of codes now clarify that you must report nerve injection codes one per nerve, branch, or plexus, no matter the number of injections that are done. Codes that include image guidance have been clarified so you’re aware when you can separately report imaging guidance. For codes 64400-64450, you are able to report imaging guidance separately. However, imaging guidance is included in and an inherent component of codes used for paravertebral blocks (64461-644-63, TAP blocks (64486-64489), and transforaminal epidural injections (64479-64484. It’s also been included in the codes that are new for 2020 to describe sacroiliac and genicular injections and destruction. 

Related Link: Best Practices for Pain Management Billing and Coding

For somatic nerve injections, the parent code has been revised by the addition of an (s) to note that multiple injections have been included. The codes for injection of cervical plexus (64413), phrenic (64410), and facial (64402) have been deleted because they’re rarely performed by clinicians. In the case they are performed, then you’ll need to report the unlisted code 64499.

The injection of the intercostal nerve (64421) code has also been changed and is now an add-on code that can be reported on every extra level of intercostal nerve injections. You’ll now bill it along with code 64420. The codes for 2020 read as follows: 

  • CPT Code 64420 – Anesthetic agent(s), steroid, and or injection(s): the intercostal nerve and a single level
  • CPT Code +64421 – intercostal nerve used for every additional level (should be listed separately along with the code used for the primary procedure)

For injections that go into nerves that innervate the sacroiliac joint and include CT guidance or fluoroscopy, a code has been added for 2020 – CPT code 64451. If ultrasound guidance is used while performing these injections, then report the 76999 unlisted code. CPS added some notes on this code, instructing users to avoid reporting these services along with codes describing radiological guidance, guidance codes for chemodenervation, or paravertebral facet joint injections. If the procedure is performed bilaterally, then modifier 50 must be appended to the code. 

There’s also a new code for radiofrequency ablation of sacroiliac nerves that includes imaging guidance – CPT code 64625. It’s not to be reported along with the destruction of sacral or lumbar facet joint, guidance codes for chemodenervation, or radiological guidance. However, when bilateral procedures are done, it also may be reported with modifier 50. 

Another brand new code is the code for injection of genicular nerves (CPT 64454). With this code, injection of all nerve branches is required, including superomedial, inferomedial, and superolateral. In the event that all nerve branches aren’t injected, then the modifier for reduced services (modifier 52) must be reported to this code. Any codes that describe destruction of the genicular nerves should not be reported along with this new code. 

For the destruction of genicular nerve branches, CPT code 64624 has been added. However, just like the previously mentioned injection code, destruction of all three nerve branches are required. This code also includes imaging guidance, and in the event all nerve branches aren’t destroyed, then modifier 52 is required. 

These coding changes went into effect on January 1, 2020, and it’s important to ensure you’re using the code that’s most specific to services provided. Ensure that physicians, staff, and other providers are well aware of these changes to prevent payer reviews or denials. 

Opioid Treatment Services – CMS Proposal

Beginning on January 1, 2020, the new proposal for opioid treatment services from CMS went into effect. CMS will now pay Opioid Treatment Programs for treatment services related to opioid use disorder when provided to individuals who have Medicare Part B. These services include toxicology testing, counseling, and medication-assisted treatment medicines. They plan to do a bundled payment to programs certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by an accrediting body approved by the SAMHSA. In order to be paid for opioid use disorder services, the program needs to be enrolled in Medicare.

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CMS also noted that they’re continued to focus on the reduction and prevention of opioid use disorder by encouraging the use of non-opioid pain medicines and safe opioid prescribing practices. They also requested information to help with the development of an action plan that will improve access to medication-assisted treatment and prevent addiction to opioids, expanding upon the current CMS Roadmap: Fighting the Opioid Crisis.

E/M Coding Changes 

 It’s also essential for pain management practices to be aware of the E/M coding changes, as well as the modifications to documentation requirements for the coming year and in the future. The Final Rule for 2020 included a 2020 PFS conversion factor of $26.09, which is just $0.05 higher than the conversion factor for 2019. This conversion factor gets multiplied by total relative Value Units in order to come up with the payment amount of services that are a part of the Medicare Physician Fee Schedule. 

CMS confirmed that it plans to align E/M coding with the American Medical Association Current Procedure Terminology Editorial Panel changes for outpatient/office E/M visits. It also accepted the recommended work values from RUC for services. However, these changes don’t go into effect until 2021, although it’s essential to begin familiarizing yourself with them. 

For pain management specialists, the changes are pretty significant for 2020, and ensuring you comply with the changes is critical to ensuring you get maximum reimbursement and avoid denials. M-Scribe specializes in medical billing and more, and we can help your pain management practice stay current with changes to prevent delays and denials that cost your practice. Contact M-Scribe today for more information. 


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