Neurology & Pain Management Coding Alert

Also, remember add-on codes where appropriate.

The number of patients needing chronic pain management (CPM) seems to have increased in the last decade. As such, Medicare has responded with some new codes for the service.

The basics: Medicare now has two new codes for these services; their descriptors are involved, as are the requirements to use them.

Read on to discover what the CPM codes include and to learn the not-so-obvious coverage requirements revealed in the 2023 Medicare Physician Fee Schedule (MPFS) final rule.

Advice: Read the G Code Descriptors Closely

The descriptors for the new CPM codes are long, and you must read them carefully to understand the requirements. The italicized wording below quotes the code descriptors, but adds bullets in G3002 to make it easier to identify each element:

• G3002 (Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring;
• administration of a validated pain rating scale or tool;
• the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes;
• overall treatment management;
• facilitation and coordination of any necessary behavioral health treatment;
• medication management;
• pain and health literacy counseling;
• any necessary chronic pain related crisis care; and 
• ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate.
• Required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional;
• first 30 minutes personally provided by physician or other qualified health care professional, per calendar              month. (When using G3002, 30 minutes must be met or exceeded.))
• +G3003 (…Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month. (List separately in addition to code for G3002. When using G3003, 15 minutes must be met or exceeded.))

Know Details Before Using CPM Codes

As detailed as the code descriptors are, there is a lot more you need to know to apply these codes accurately. The MPFS final rule answers many questions in its discussion of these codes. To read the specifics, go to www.federalregister.gov/d/2022-23873/ page-69524 and scroll to the header “(33) Chronic Pain Management and Treatment (CPM) Bundles ….”

Descriptor elements required? Providers must furnish all appropriate elements of the code descriptor. The key term is appropriate because not all patients require every element.

Chronic pain definition: For these codes, Medicare defines chronic pain as “persistent or recurrent pain lasting longer than 3 months.”

At the first visit, the patient doesn’t need to have an established history or diagnosis of chronic pain. The patient also doesn’t need to be diagnosed with a condition that causes or involves chronic pain. But “it is the clinician’s responsibility to establish, confirm, or reject a chronic pain and/or pain-related diagnosis when the beneficiary first presents for care and the clinician first reports” G3002, the final rule states.

In person: The first time you report G3002, a physician or other qualified healthcare professional (QHP) must see the patient in person in a clinical setting. Beyond that, the provider may decide to furnish any in-person components using telehealth to increase patients’ access to care.

Frequency: In conjunction with G3002 for the first 30 minutes, you may report +G3003 for each additional 15 minutes an unlimited number of times per calendar month.

Additional services: You may report both evaluation and management (E/M) and CPM codes on the same day when documentation shows the encounter met all requirements to report each service separately. Of course, you should not double-count time. Don’t include time spent on another reported service when calculating the CPM time.

Similarly, Medicare allows you to report CPM and remote patient monitoring, remote physiologic monitoring, or remote therapeutic monitoring together when documentation supports doing so.

Multiple providers? The final rule “noted that it is unlikely that a patient with pain would want or need to see more than two physicians or other qualified health professionals in the same month to manage their pain through CPM, but declined to restrict the number of clinicians who can bill the CPM codes at this time,” stated attorneys Carrie Nixon, Kaitlyn O’Connor, and Stephanie Barnes of Nixon Gwilt Law in a blog post about the new codes (https://nixongwiltlaw. com/nlg-blog/2022/11/17/reimbursement-for-chronic-pain-management-in-the-2023-medicare-physician-fee-schedule-new-opportunities-for-patients-and-providers).

The MPFS final rule provides some examples on coding. Scenario 4 explains that it may be appropriate for both a family physician and a pain management specialist to report G3002 in a single month if the family physician transfers care to the pain management specialist (www.federalregister.gov/d/2022-23873/ page-69545).

Expect Slightly Higher Pay in Office Setting

While the MPFS final rule gave only the work relative value units (RVUs) for the new codes, the MPFS file for the first quarter of 2023 shows G3002 has 2.39 total RVUs in the nonfacility setting and 2.17 RVUs in the facility setting. If you multiply that by the 2023 conversion factor of $33.0607, the results are roughly $79.02 (nonfacility) and $71.74 (facility). For +G3003, the nonfacility total RVUs of 0.87 and facility RVUs of 0.75 calculate to about $28.76 and $24.80.