Wiki Facility charge for Pain Management

[missyah20]

Good morning All -

I am trying to help out a CRNA who does pain management procedures at a Critical Access Hospital (no pass thru at this facility). They have moved him off the OR floor and given him his own procedure room due to case volume.

I am not familiar with the facility side so I am hoping someone can give me some guidance for this provider. He is wondering how the facility would charge for the facility fee for the ESI, Facet, etc.

The facility would use the same CPT code (62311, 64493, etc) that he would use for his Pro Fee portion, correct? Currently he said the facility wanted to use code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular).

Also if anyone could let me know of any resources out there to help that would be great.

 

[dwaldman]

The procedure code that represent the procedure the provider is performing should be reported. The carrier needs to be aware of what service was provided and if that is covered for the specialty. And if criteria was met for the type of procedure that was performed. They should request a meeting and require clarification on the coding that is being proposed to use for his services.