# Pain Management - Medicare regulation



## dstruve (Aug 24, 2010)

Our ASC is looking in to doing pain management. Is there a Medicare regulation that patient's have to have an xray? This sounds strange to me as I have had an epidural flood and I had an MRI confirming my dx but nothing during my procedure. Any help on this issue or advise for epidural floods please feel free. Thanks.


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## marvelh (Aug 26, 2010)

The following are CPT rules and not Medicare specfic:

SI joint injections CPT code (27096 physician or G0259/G0260 Medicare ASC) require radiologic imaging in order to code

Paravertebral facet joint injection codes (64490 - 64495, new for 2010) also require radiologic imaging in order to code

Many pain management injections / procedures are performed under radiologic imaging but not due to Medicare requirement but decrease risk of intravascular or intrathecal injection and to document / verify needle placement in diagnostic injections.


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## dstruve (Aug 27, 2010)

*Pain Management*

I thought epidural floods were 62281 and 62282??


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## dwaldman (Aug 27, 2010)

If you look at the Lay Description for 62281 or 62282 it is mentioning using fluoroscopic guidance. I would assume if you are injecting a neurolytic substance that needle placement with assistance of the fluoro machine would be deemed necessary by the physician.


This procedure is performed to destroy nerve tissue or adhesions. The patient is placed in a spinal tap position. The site is sterilized, and the needle is inserted under fluoroscopic guidance. The needle is placed at the proper level and the neurolytic substance is administered. Once the injection/infusion is completed, the needle is removed and the wound dressed. Report 62280 if the substance is administered to the subarachnoid level. Report 62281 if the needle is inserted in the epidural region of a cervical or thoracic level. Report 62282 if the needle is inserted in the epidural region of a lumbar or sacral (caudal) level.


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## dstruve (Aug 30, 2010)

*Pain Management*

The orders are marked Lumbar S1, 2nd injection. Would this then be billed as 62311? This is for our ASC only. Do we include our medications in this facility fee or am I able to bill those separately?

I really need a class for this.


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## ttest2007 (Aug 30, 2010)

*Radio Frequency Occipital Nerve Block*

When doing a occipital radio frequency nerve block what cpt codes are used


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## dwaldman (Aug 30, 2010)

Can you provide the procedure note? Lumbar S1 does not automically mean 62311. Does the physician use the term "epidural flood" in the procedure note? Or does someone other than a physician use this term to describe a procedure?


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## dwaldman (Aug 30, 2010)

In regards to the Occipital Radiofrequency, you would want to confirm that this is a Non-pulsed and I think you could report 64640. If the procedure note states that it is pulsed then you would use 64999.


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