4 Common Interventional PM Procedures You Can’t Afford To Miss

Get the lowdown on when to code separately for fluoroscopy.

If your physician performs interventional pain management (IPM) services, you’ll need to be up to speed on four top IPM procedures to make sure you’re earning full deserved reimbursement for your claims.

Difference: Pain management specialists are physicians who study pain and perform less invasive injections (soft tissue, peripheral nerve, and joint injections) and medication management to help relieve patients’ pain. One common pain management procedure is trigger point injection (20552, Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) or 20553, single or multiple trigger point[s], 3 or more muscle[s]). An interventional pain management specialist’s scope includes spinal diagnostic and therapeutic procedures and other invasive techniques like nerve stimulator or opioid pump insertion, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. When submitting claims, you’ll use specialty designation 72 for pain management or 09 for interventional pain management.

Learn the Most Common Injections

All injections are not created equal – and they’re not coded the same. Here’s your guide to four types of treatments that commonly fall under the IPM umbrella.

Facet injections: CPT® includes a range of codes describing the various sites and levels associated with paravertebral facet joint and facet joint nerve injections. You’ll find these in code family 64490-64495 (Injection(s), diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT]). If your physician uses ultrasound guidance during the injection procedure, turn to the Category III code section of CPT® instead. There you’ll find codes 0216T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance). You’ll choose the appropriate code based on the anatomic injection site...

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CCI Edit: 93454-93461 Note These Column Changes For Correct Cardiology Coding

Correct Coding Initiative version 17.1 brings 11,831 new edit pairs, effective April 1 for physicians. That’s the word from a March 17 announcement by Frank Cohen, principal and senior analyst for the Frank Cohen Group. Here’s a look at the major pointers you need to keep in mind to comply with the new cardiology-related edits, including cardiac catheterization, radiological supervision and interpretation, cardiac rehabilitation, and more.

1. Prevent Denials by Remembering 93454-93461 Are Diagnostic

New edits will prevent you from reporting heart catheter/angiography codes 93454- 93461 (column 2) with the following cardiovascular therapeutic services and procedures (column 1):

  • 92975 — Thrombolysis coronary; by intracoronary infusion, including selective coronary angiography
  • 92980 — Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
  • 92982 — Percutaneous transluminal coronary balloon angioplasty; single vessel
  • 92995 — Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel.

The 929xx codes in column 1 describe coronary therapies. The 934xx codes in column 2 are diagnostic procedures. You should never use the 934xx diagnostic codes in column 2 to report catheter placement and coronary angiography performed as an integral part of the therapeutic column 1 services.

Opportunity: The edits have a modifier indicator of 1, so you may override them with an appropriate modifier when the procedures are distinct. If you report both codes in the edit pair and don’t append a modifier to the column 2 code, Medicare (and payers applying Medicare rules) will reimburse you for only the column 1 code.

The AMA, via CPT Assistant (April 2005), indicates that you may report a true diagnostic catheterization in addition to the therapeutic procedures described by 92980 and 92982: “These two distinct procedures (diagnostic catheterization and therapeutic procedures), therefore, should...

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95992: CRP Code Wins Payable Status

Medicare still won’t reimburse audiologist-billed Epley. After two years of battles with CMS over canalith repositioning procedure (CRP) coding, physicians will finally get paid for these specific codes. CPT® 2009 excited ENT coders with new CPT cod...

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Check New HCPCS Codes to Keep Pain Management Claims on Track

Catch the changes to botulinum toxin and neurostimulator electrode codes. As a pain management coder, you’re facing new CPT codes for posterior intrafacet implants, paravertebral facet joint injections, and sacroplasty. While preparing to implement these additions, don’t overlook HCPCS changes for botulinum toxin injections and implantable neurostimulator electrodes. Pay Attention to Botox Units A new code for botulinum [...] Related articles:

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