Does Your Practice Treat Pain? AAOSNow – August 2019 by Cheryl Toth Interventional pain management is a growing specialty, and many orthopaedic groups have added an interventionalist to the physician team. If this is the case for your practice, make sure the interventionalist understands the reimbursement and documentation nuances essential to optimizing payment and mitigating...
Category: Physiatry
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New Patient or Established
November 1, 2018 Question: If I see a new patient in consultation for a joint pain, treat and release them to their primary care provider and they come back to see me a year later for a different reason on their own, can I code them as a new patient? Answer: No. According to the...
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Femoral Nerve Block
October 18, 2018 Question: My physician has just started performing adductor canal continuous infusion pain blocks? How do I code it? Answer: The correct CPT code is 64448 (Injection, anesthetic agent; femoral nerve, continuous infusion by catheter (including catheter placement) when a catheter is placed and infusion performed. *This response is based on the best...
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Ultrasound Documentation
October 4, 2018 Question: What needs to be documented when I perform a procedure using ultrasound guidance? The insurance company denied the service after requesting my procedure note saying it was not documented and will not pay for the service. Are there any guidelines for this? Answer: According to the CPT guidelines for Radiology services,...
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Multiple Procedure Payment Formula
September 20, 2018 Question: What is Medicare’s multiple procedure payment formula? When I do more than one procedure, I know Medicare reduces payment for some but I can’t remember by how much. Answer: It used to be 100%, 50%, 25%, 25%, etc but many years ago the formula changed to the physician’s advantage and now...
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Code Submission Order on Claims
September 6, 2018 Question: When we are submitting multiple procedures on a claim, should we submit the CPT codes in the order the procedures were performed, or the most serious findings first, or does it matter? Answer: You should submit codes in descending relative value unit (RVU) order. If you don’t have software that gives...
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NPP Reporting and Claim Form Line 24J
August 23, 2018 Question: How do we know whether to put the NPP (PA or NP) or physician NPI number in box 24J on the claim form? Answer: When services are reported using the Direct billing method, the NPI of the provider performing the services places their NPI number in box 24J. When services are...
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Documenting the Initial Pain Assessment
August 9, 2018 Question: What needs to be documented for the initial assessment for a pain management patient to support medical necessity for interventional pain management procedures? Answer: To support medical necessity, documentation should include the site of pain, along with the severity of pain (pain scale 0-10. It is important to also document the...
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Facet Joint Injections without Guidance
July 26, 2018 Question: If I perform a facet joint injection of the Medical Branch (64490-64495) and don’t use guidance, can I still report these codes? Answer: No, according the many of the medical policies if guidance CT, US or Fluoroscopic is not used the service is reported as a trigger point injection (20552 or...
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Pain Management Resources
July 12, 2018 Question: What are some good organizations to reference for pain management guidance? Answer: Good reference information can be found from the AAPM&R, American Academy of Pain Medicine, The American Pain Society and the American Society of Interventional Pain Physicians. It is also important that you reference the individual payor websites to access...
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