# new pain management doctor



## Jennifer17 (Mar 2, 2016)

I am and have been in orthopaedics for a very long time and now we will be hiring a pain management doctor which I know nothing about coding for. Does anyone have a superbill or anything with common codes or any advice on learning pain management - of course I will be looking into seminars also.

Thanks in advance


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## dwaldman (Mar 2, 2016)

Below is list of pain management codes I found from the below link, I copy and pasted a lot of the codes from the link but there could other codes needed. I would look at the local coverage determination policies for Medicare carrier in your state and you can get familiar with the ICD-10 codes that meet medical necessity and the documentation requirements. Lately they seem to be update those policies more frequently and it is importantly to watch for draft policies and future changes. Additionally Aetna, Cigna, UHC, BCBS have policies that you want to be familiar with. Most of the policies describe the requirement of fluoroscopic guidance for facet, SI joint, and potentially epidurals, And typically do not cover their ultrasound guided counterpart.

http://thepainsource.com/cpt-codes-pmr-pain-management-billing-and-coding/


Joints and Bursa – Injection or Aspiration
Major joint/bursa:  20610 (knee, hip, shoulder, trochanteric bursa, subacromial bursa, pes anserine bursa)
Intermediate joint/bursa:  20605 (temporomandibular, acromioclavicular, wrist, elbow, ankle, olecranon bursa)
Minor joint/bursa:  20600 (fingers [PIP, DIP], toes)
Sacroiliac joint (SIJ) with fluoroscopy:  27096
Sacroiliac joint (SIJ) without fluoroscopy:  20552 (billed as a trigger point injection)
Genicular nerve blocks:  64450 
Genicular nerve RFA:  64640
Carpal tunnel injection:  20526

Tendons, Ligaments, and Muscle Injections
Tendon sheath or Ligament:  20550 (iliolumbar ligament, trigger finger, De Quervain’s tenosynovitis, plantar fascia)
Tendon origin/insertion:  20551
Trigger point injection (1 or 2 muscles):  20552
Trigger point injection (3 or more muscles):  20553
Sacroiliac joint (SIJ) without fluoroscopy:  20552 (billed as a trigger point injection)

Nerve Blocks
Greater occipital nerve block:  64405
Lesser occipital nerve block:  64450
Other peripheral nerve:  64450 (I use this for superior cluneal nerve blocks, and genicular nerve blocks)
Other peripheral nerve:  64640 (used for S1, S2, S3 lateral branches during RFA)
Suprascapular nerve:  64418
Intercostal nerve (single):  64420
Intercostal nerve (multiple):  64421
Ilioinguinal and Iliohypogastric nerve:  64425
Trigeminal nerve (any branch):  64400
Sphenopalatine ganglion:  64505
Stellate ganglion (cervical sympathetic):  64510
Superior hypogastric plexus:  64517
Thoracic or lumbar paravertebral sympathetic:  64520
Celiac plexus:  64530
Plantar common digital nerve (Morton’s neuroma):  64455
Unlisted procedure:  64999

Epidural Steroid Injections (ESI)
 
Interlaminar
Interlaminar – cervical or thoracic:  62310
Interlaminar – lumbar or sacral (caudal):  62311
Interlaminar-cervical or thoracic: 62318 Infusion greater than single calendar day
Interlaminar-Lumbar/Caudal 62319 Infusion greater than single calendar day


 
Transforaminal
Transforaminal – cervical or thoracic (first level):  64479
Transforaminal – cervical or thoracic (each additional level):  64480
Transforaminal – lumbar or sacral (first level):  64483
Transforaminal – lumbar or sacral (each additional level):  64484

Facet Joint Procedures
 
Intraarticular Joint or Medial Branch Block
Intraarticular joint or medial branch block (MBB) – cervical or thoracic (1st level):  64490
Intraarticular joint or medial branch block (MBB) – cervical or thoracic (2nd level):  64491
Intraarticular joint or medial branch block (MBB) – cervical or thoracic (3rd level):  64492
Intraarticular joint or medial branch block (MBB) – lumbar or sacral (1st level):  64493
Intraarticular joint or medial branch block (MBB) – lumbar or sacral (2nd level):  64494
Intraarticular joint or medial branch block (MBB) – lumbar or sacral (3rd level):  64495

Radiofrequency Ablation (RFA) / “Destruction” of Facet Joint
Radiofrequency ablation (RFA) – cervical or thoracic (1st joint):  64633
Radiofrequency ablation (RFA) – cervical or thoracic (each additional joint):  64634
Radiofrequency ablation (RFA) – lumbar or sacral (1st joint):  64635
Radiofrequency ablation (RFA) – lumbar or sacral (each additional joint):  64636

Vertebroplasty / Kyphoplasty

Vertebroplasty
Vertebroplasty – Cervicothoracic (1st level):  22510
Vertebroplasty – Lumbosacral (1st level):  22511
Vertebroplasty – Each additional level of the above:  +22512

Kyphoplasty
Kyphoplasty – Thoracic (1st level):  22513
Kyphoplasty – Lumbar (1st level):  22514
Kyphoplasty – Thoracic or Lumbar (each additional level):  +22515


Implantation of Spinal Cord Stimulator Percutaneous Leads and Generator
Percutaneous implant of electrode array:  63650 (includes 10-day global)
Insertion or replacement of pulse generator:  63685 (includes 10-day global)

 
Implantation of Spinal Cord Stimulator PADDLE Leads and Generator
Laminectomy for implant of neurostimulator electrode, paddle:  63655 (includes 90-day global)
Insertion or replacement of pulse generator:  63685 (includes 10-day global)

 
Removal of Leads/Generator (Explant)
Removal of spinal neurostimulator percutaneous array(s):  63661 (includes 10-day global)
Removal of spinal neurostimulator paddle electrode:  63662 (includes 90-day global)
Removal of pulse generator:  63688 (includes 10-day global)

Discogram / Discography
Discogram / Discography – Cervical/Thoracic (each disc):  62291
Supervision & interpretation of fluoroscopy – Cervical/Thoracic (each disc):  72285
Discogram / Discography – Lumbar (each disc):  62290
Supervision & interpretation of fluoroscopy – Lumbar (each disc):  72295


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## Jennifer17 (Mar 3, 2016)

Thank you very much!


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