Pain Management Billing and Coding Simplified: Your Road to Financial Success
Pain management specialists are experts in the diagnosis, treatment, and management of acute or chronic pain from tissue and nerve injuries. Patients who experience chronic pain often have significant needs for pain management therapy in order to succeed in their day-to-day lives.
In order to provide reliable, comprehensive care to your patients, it’s essential to ensure your practice functions smoothly and your team doesn’t have to worry about complex pain management billing codes , claim denials, evolving reimbursement policies, and more.
Medical billing, coding, and documentation challenges are inevitable for private practitioners.
Tackling Major Challenges in Medical Billing & Coding for Pain Management Services
Regulations in the field of interventional pain management are imposed by the federal government, medical boards, state governments as well as many other regulatory agencies. Proper documentation of all medical services with corresponding medical codes and appropriate bills is an important aspect of interventional pain management. The financial feasibility of any interventional pain management practice is severely impacted by every change that occurs in the regulations governing this field.
Treatment approaches for pain vary depending on the specific disease, disorder, type, and location of pain. Managing pain management revenue cycle (RCM) is crucial to the efficient operation of healthcare facilities.
Avoid Billing Based Specifically on Summaries
One of the most common errors in pain management billing and coding is invoicing a procedure based only on a summary. According to Medicare, you can only bill for operations that are detailed in the body of a report. This implies that for coding reasons, programmers must go beyond the summary at the top of the report.
Make Sure Errors in Medical Records are Fixed
Since meeting documentation requirements is critical to ensuring that payers actually pay for services, dealing with errors in medical records appropriately is crucial. Doctors shouldn't scratch out words or use correction fluid in patient records. An error in a patient's record should be marked with an ink line, with the word "error" above it, and the correction should be made. It is also essential for physicians to initial the corrections made in the records.
Examine and Verify Codes Listed in Reports
Another costly pain management billing and coding error is to simply list codes provided by physicians in reports. Proper coding involves examining the reports and ensuring that if the codes effectively and properly reflect the physician's services. It is also critical to ensure that proper documentation for procedures being coded has been given.
Hence the crucial aspect of pain management billing and coding process is the accurate usage of pain management codes as specified according to the CPT and ICD guidelines.
Stay Alert on “Canned” Reports
For some treatments, physicians may utilize "canned" reports or report templates rather than generating a report suited to the individual patient and pain management method. Unfortunately, some templates may not include all of the information required for adequate documentation. In rare situations, the report may not offer information on the specific operations carried out or specify which side the procedure was carried out on.
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, intra-articular joint or medial branch block facet joint procedures, transformational epidural steroid injections, and radiofrequency ablations. Billing fluoroscopy separately frequently results in duplicate claims being submitted for a single operation, resulting in expensive denials that impact your bottom line.
Remember the 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.
Avoiding the Top Errors in Pain Medicine Coding
It's more critical than ever to have a cutting-edge revenue cycle management procedure in place, along with best coding and billing practices. Let's take a look at the top five coding mistakes made by pain care providers to guarantee maximum reimbursement today and in the future:
Failure to Provide Appropriate Visit Documentation:
In pain treatment, accurate and full documentation is more critical than ever, with rejections being made owing to missing information on numerous concerns, such as laterality or which nerves were treated. In the initial operational note or an addendum, providers must give detailed, accurate treatment information. Coders must be professionals in clarifying information discovered in notes and coding correctly based on the most recent coding recommendations once they are given to the business department.
Failure to Stay Current on Payer Policies and Guidelines:
To secure maximum reimbursement, providers and coders must remain up to date on changes in insurance payer policy. This might sometimes necessitate investigative effort to collect information from updates and documents from a wide range of insurance payers.
During the COVID-19 pandemic, for example, telemedicine adjustments influenced patient E/M codes and ICD-10-CM codes.
Separate Billing for Fluoroscopy:
Many pain treatment provider’s bill for fluoroscopy separately from the procedure. Check to see if this is a bundled charge for the procedure, such as SI joint (27096), medial branch blocks, or facet injections. Alternatively, if it is recognized individually, such as fluoro guidance codes for peripheral joints.
Modifiers in Pain Medicine:
Modifiers are designed to identify the therapy or surgery done and, when ignored or misappropriated, can have a significant impact on income, leading to rejections.
LT – anatomically leftRT – anatomically right50 – bilateral59 – notes that a service or procedure is independent and separate from other services that were performed on that same day52 – incomplete procedure; stopping part of the procedure due to reasons other than patient well-being53 – incomplete procedure; the physician chooses to end a procedure for the patient’s well-being
Excessive Numbers of Approved Procedures:
Pain management necessitates careful monitoring of the amount of treatments performed in comparison to the number of authorized visits. Exceeding the permissible limit is fairly prevalent and will be prohibited.
Coding errors may add up to 180 days to payment timelines and adversely affecting the bottom line.
Pain Management ICD-10 Codes
The ICD-10-CM Official Guidelines for Coding and Reporting involve extensive notes and instructions for coding pain management.
Some common pain management ICD 10 codes:
0 for Central pain syndrome Chronic Condition11‑G89.18 G89.1 for Acute pain, not elsewhere classified21‑G89.29 G89.2 for Chronic pain, not elsewhere classified3 Neoplasm-related pain (acute) (chronic) Chronic Condition4 Chronic pain syndrome
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 is huge room for expansion, some of the pain management billing and coding issues make it tough to succeed. When it comes to increasing practice revenue, successful billing and coding is like winning half the battle.
At BillingMD360, we are committed to supporting your practice with medical billing, coding, and revenue cycle management. Our medical billing services conform to the highest standards of HIPAA compliance requirements, and our staff includes certified professionals.
So, whether you're a small pain management clinic or a larger practice, our goal is to help you optimize your revenue stream.
Let us handle the complexities of your pain management billing and coding so that you can focus on what you do best – providing exceptional care to the millions of Americans in need of pain management services.