Pain Management Billing and Coding - The Proper Way to Do It

Pain Management Coding can be complicated if you don't know what you are doing. But if you know how to do it and you understand how your physician perform these procedures, it is not hard.
I have been a Pain Management Coder for nearly 10 years now. And I love Pain Management! as much as I also love coding for Orthopedic, General Surgery and Anesthesia services.
Key pointers that you need to remember when coding for Pain Management Services:
1. Most of the Pain Management Coding for spinal injection procedures are UNILATERAL procedures. Therefore, these codes are reported once per level, per region or per site regardless of the number or type of injection performed per level, per region and per side.
2. It is inappropriate to report injection on the spine procedures for each injection performed at a particular level and side.
3. If both sides of the same joint level/site/side are injected, then modifier -50 must be appended to the specific injection procedure code to indicate that bilateral procedures were performed.
Here's a useful tip: Report only 1 unit when performed on the same level. Because the modifier -50 is already indicating 2 sides (a left and a right).
For example a bilateral 64490 should be billed as 64490 with modifier -50 for 1 unit.
3. Fluoroscopic Guidance - most of the Fluoro are now being bundled with the CPT codes. So be careful with not billing for CPT Code 77003. Read the description of the CPT code procedure first.
Here are just some of your pain management procedures:
Transforaminal Epidural Injections
Interlaminar / Caudal Epidural Injections
Facet Joint Nerve Block
Facet Joint Nerve Destruction
Sacroiliac Injections
Musculoskeletal Injections
Somatic Nerve Blocks
Sympathetic Nerve Blocks
Discography
IDET / Nucleoplasty
Pump Implants
Spinal Stimulator Implants
Let's look at this honest mistake that my one of my readers sent me via email:
The email said: "We have been getting denials for CPT code 64484 for additional levels as - "the code do not support medical documentation"
And this was my reply to that email:
"Well, let's look at what the pain doc actually performed"
64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level
64484 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)
Now, read your Physician's documentation, is it really an add-on level? or maybe it is a bilateral procedure (left and right side) or unilateral;
If it is bilateral, then you do not need the 64484 - remember this code is only be used for each additional level (not for the other "anatomical side" - left or right!). If it is bilateral, you need to use the modifier 50.
Modifier 51 for 64484 is NOT allowed.
Please visit my website and learn more on how to properly code and bill for your physician pain management services.

Ms. Pinky is a Computer Support Specialist for more than 25 years. Has a Bachelor of Science Degree in Computer Engineering, MS Research work in Systems Engineering. A Systems Engineer, Information Technology Consultant and an Independent Medical Billing and Coding Consultant.

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