Medicare Compliance & Reimbursement

Know what specialists do to win the coding battle As pain management continues to grow, your coding accuracy depends on understanding the subtleties between specialties. If your physicians are branching into the area of interventional pain management, the following tips can help you report their services accurately. Check Differences Between PM and IPM Pain management specialists are board-certified physicians who study pain and perform manipulations and small injections (such as trigger point injections, 20552, Injection[s]; single or multiple trigger point[s], one or two muscle[s]; and 20553, ... single or multiple trigger point[s], three or more muscles) to help relieve patients' pain. An interventional pain management specialist's scope of practice is slightly different. "Anesthesiologists are most often interventional pain management specialists because their training includes nerve blocks and other invasive techniques like stimulator and opioid pump insertion," says Scott Groudine, MD, an anesthesiologist in Albany, NY. "Many patients, however, can be successfully treated with less invasive techniques such as pharmacology, psychiatry and physical therapy." Carrier perspective: In the past, CMS recognized pain management and interventional pain management as separate specialties with their own designations. But now you report both specialties under the specialty designation 09 (Interventional pain management) on the 855i application form. Here's What Is Covered Under the IPM Umbrella Interventional pain specialists most often perform services related to fluoroscopy or injections. Common procedures include: 1. Fluoroscopy. CPT lists several fluoroscopy codes, but interventional pain specialists most often focus on 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic destruction). Follow the rules: Use caution when coding fluoroscopy, however. When your physician uses fluoroscopy for needle placement, report 77003 in addition to the code for the epidural, spinal or articular injection. But if your physician performs a RACZ procedure, you shouldn't separately report the services. Here's why: The RACZ codes (62263, Percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., catheter] including radiologic localization [includes contrast when administered], multiple adhesiolysis sessions; 2 or more days; and 62264, ... 1 day) include both the RACZ and fluoroscopy services, so you can't unbundle the fluoroscopy. 2. Spinal injections. Your specialist may administer spinal injections to treat chronic pain due to an injury, spinal tumor (benign or malignant), or other problems such as intractable terminal cancer. Report 62280 (Injection/infusion of neurolytic substance [e.g., alcohol, phenol, iced saline solutions], with or without other therapeutic substance; subarachnoid), 62281 (... epidural, cervical or thoracic) or 62282 (... epidural, lumbar, sacral [caudal]), depending on the injection site. 3. Facet injections. Codes 64470-64476 describe various [...]