Anesthesia Coding Alert

As the pain management field continues to grow, so do the specialty areas within the field. One important specialty is interventional pain management, with specialists trained to perform delicate procedures such as fluoroscopy, SI joint injections and diskography. The following tips can help you determine how to accurately report interventional pain management services. Know What Falls Under Interventional PM Pain 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). Because interventional pain management specialists complete fellowships and additional training, plus pass additional board-certification exams, their scope of practice is slightly different.

"Medicare recognizes interventional pain management as a separate specialty," says Abraham Rivera, MD, CEO of Pain Management Medical Group in Albany, N.Y. "However, Medicare and some other carriers usually won't change the practitioner's designation to interventional pain management specialist (Type of Service - or TOS - 09) unless he or she is board-certified by at least one of the certifying bodies."

After the carrier designates the practitioner as an interventional pain management specialist, your practice can collect reimbursement for procedures for which other physician specialties (such as anesthesiologists or neurologists) can't collect.

Rivera and Laxmaiah Manchikanti, MD, president and executive director of the American Society of Interventional Pain Physicians (ASIPP) in Paducah, Ky., cite several procedures as examples of the types of services interventional pain specialists perform:

Fluoroscopy. CPT lists several fluoroscopy codes, but interventional pain specialists use 76005 (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 agent destruction) most often.

You must use caution, however, when reporting fluoroscopy, Rivera says. "The rule is that if you're doing fluoroscopy strictly for needle placement, then code 76005 applies in addition to the codes for the epidural, spinal or articular injections," he says. "The only exception is a RACZ procedure, where everything is included and you cannot unbundle the fluoroscopy part." (Report RACZ procedures with either 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, or 62264, ... 1 day.)

Spinal injections. 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]), for spinal injections, depending on the injection site.

Facet injections. Codes 64470-64476 describe various sites and levels associated [...]