Anesthesia Coding Alert

Check to see whether your group should change designations

If your providers offer more complicated pain management procedures than simple injections, don't follow anesthesiology coders' leads and report your pain management specialists' services with a type of service (TOS) of 07 (Anesthesia). Your reimbursement could suffer if you should actually be reporting a TOS of 09 (Interventional pain management) instead. Use this expert strategy to determine which TOS works for you.

Why Interventional Pain Management Is Different

Interventional pain management is a specialized area of pain management practice. According to the National Uniform Claim Committee (NUCC) of the AMA, interventional pain management is "the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders with the application of interventional techniques in managing subacute, chronic, persistent and intractable pain, independently or in conjunction with other modalities of treatments."
 
Interventional pain management physicians use special procedures to diagnose, treat and manage various types of pain. The term "interventional" indicates that the physician injects or places substances or other materials in the body when treating the patient.

Recognize Interventional Specialists' Services

Many patients who see interventional pain specialists have pain from postoperative procedures or malignancies, or have ongoing pain in the low back, neck, shoulder, head or other area. Interventional specialists investigate the cause and location of a patient's pain and how the pain signals are transmitted. Once this is determined, the physician suggests modifications to existing therapies (such as medication) and recommends other diagnostic or treatment modalities (such as MRIs or pain management treatments).
 
An interventional pain specialist is specialty trained to administer interventional techniques, says Laxmaiah Manchikanti, MD, president and executive director of the American Society of Interventional Pain Physicians (ASIPP) in Paducah, Ky.
 
Note an important distinction between an interventional pain specialist and a pain specialist: A pain specialist (designated by TOS 72) is a board-certified physician who studies pain and performs manipulations and small injections. These include trigger point injections (20552, Injection[s]; single or multiple trigger points, one or two muscles, and 20553, ... single or multiple trigger point[s], three or more muscles) and joint injections (20600*, Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes], 20605*, ... intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa; or 20610*, ... major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).
 
An interventional pain specialist, on the other hand, can perform these services as well as others such as those listed above. He or she has usually had a one- or two-year fellowship and additional training in the area and has passed another set of medical boards. Interventional pain management specialists come from the fields of surgery, neurosurgery, anesthesia, physical medicine/rehabilitation and even neurology, says Abraham Rivera, MD, CEO of Pain Management Medical Group in Albany, N.Y.

Make Claims More Accurate With 09

Supporters of the 09 TOS specialty designation say it holds a variety of benefits and potential benefits for physicians. Some benefits ASIPP mentioned in a memo to physicians this fall include: