Anesthesia Coding Alert

Millions of Americans suffer chronic pain due to fibromyalgia, reflex sympathetic dystrophy (RSD), unsuccessful back surgery and other conditions. When basic pain-relief treatments such as ibuprofen or other pain medications fail, patients are often referred to a pain management specialist for more advanced treatments. As more of these patients enter pain management care, pain management practitioners and coders wonder what services for these patients will be covered and under what conditions.
 
"We treat fibromyalgia patients all the time," says Kim McDougald, billing supervisor for the physician group West Florida Anesthesia and Pain Management in Spring Hill. The practice began focusing solely on pain management in January 2002. Although McDougald and other coders say that pain management treatment has come a long way in the last few years, many feel it still has far to go.
Proper Diagnosis
The patient's original diagnosis is crucial to correct coding and fair reimbursement. The referring physician and pain management physician often must work together to gain provider approval for treatment of the pain diagnosis.
 
Most patients with fibromyalgia that West Florida Anesthesia and Pain Management treats are diagnosed with ICD-9 729.1 (myalgia and myositis, unspecified), McDougald says. Because these patients may also experience severe muscle spasms, another fairly common diagnosis code is 728.85 (spasm of muscle). Code ICD-9 726.0 (adhesive capsulitis of shoulder) is also used occasionally, although she says they don't treat very many patients for frozen shoulder.
Chronic-Pain Treatment Options
Treatment of chronic-pain patients varies based on the individual's circumstances. McDougald and Scott Groudine, MD, an anesthesiologist in Albany, N.Y., say that five common treatments are:
 
1. Trigger point injections (TPIs) (20552, injection; single or multiple trigger point[s], one or two muscle group[s]; and 20553, single or multiple trigger point[s], three or more muscle groups). This is the most frequent treatment for chronic-pain patients, and these two codes for TPIs are new for CPT Codes 2002. The descriptor for the code formerly used for TPIs (20550*, injection; tendon sheath, ligament, ganglion cyst) no longer includes "trigger point" in the definition, so it no longer applies to these treatments. Codes for TPIs are the only procedure codes that some carriers cover for chronic-pain patients, McDougald says.
 
2. Epidural steroid injections (ESIs) (62310, injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic; or 62311, lumbar, sacral [caudal]). ESIs can be fairly common for chronic-pain treatment. McDougald says that her group frequently uses ESIs to treat [...]