Anesthesia Coding Alert

Don't risk losing allowable reimbursement

If your pain management practice uses neurostimulation to treat chronic pain, you should confirm that your patients meet your insurers' medical-necessity requirements before you perform these procedures. Many payers still consider neurostimulation investigational for some diagnoses, so your best bet is to get your carriers' policies in writing and keep an ABN nearby just in case. Neurostimulation Offers Hope for Pain Relief Neurostimulation (also called spinal cord stimulation, or SCS) uses tiny electrical impulses to block pain messages from being transmitted to the brain. Some patients experience total pain relief, while others may feel a mild tingling sensation instead of pain. Either result improves the patient's quality of life.

Neurostimulation patients typically have a variety of pain conditions, including chronic radiculopathy (sciatica), failed back syndrome, neuropathy, reflex sympathetic dystrophy, postherpetic neuralgia, or vascular insufficiency. Several criteria help determine whether neurostimulation is a viable option for the patient:

More conservative therapies (such as over-the-counter or prescription medications, trigger point or facet injections, physical therapy or corrective surgery) have failed to adequately relieve the pain. "SCS is a treatment typically recommended when all other means of treating or eliminating pain have either been ineffective or have side effects that interfere with the patient's quality of life," says Darlene Isom, billing supervisor in the anesthesia department of Northwestern Medical Faculty Foundation Inc., in Chicago.

Nerve conduction studies or other tests pinpoint the pain's origin, and the physician diagnoses the cause of pain.

Further traditional surgery to treat the pain is not indicated.

No medical issues (such as diabetes, drug abuse or misuse, or susceptibility to infection) exist that would present problems during surgery

The patient successfully passes physical and psychological evaluations. The physician should always obtain a psychological consultation before any stimulation trial, Isom says, to ensure there are no unresolved issues such as severe depression to interfere with the patient's long-term benefit.

The screening test and trial succeed. Double-check that the physician implants a dorsal column, permanently implanted stimulator. "There are other types of stimulation treatments, so be sure that you're coding for implanting a dorsal column stimulator instead of one of the other therapies," Isom says. Categorize to Prove Medical Necessity Just because neurostimulation might improve the patient's chronic pain, coding won't always be simple and reimbursement is never guaranteed. Many carriers classify diagnoses as "medically appropriate," "medically necessary" or "investigational." Knowing where your patient fits can help your coding efforts.

Before coding neurostimulation procedures, first confirm that your documentation proves the physician's previous treatment attempts and that those treatments were ineffective. Thorough documentation helps show that neurostimulation is a necessary last resort to relieve the patient's pain.

Carriers are more likely to consider charges for medically necessary services, but [...]