Pain Management Coding Alert

2019 Fee Schedule:
CMS Pauses Plan to Blend E/M Payments
Medicare offers a new payment proposal for 2021. In the annual CMS Medicare Physician Fee... Read more
Quick Q&A:
Arm Yourself With Extremity Count Before Coding These EMGs
EMG tests aren't just for CTS patients. Patients will often report to PM practices for ne... Read more
2019 Fee Schedule:
Telehealth, Virtual Care Getting More Recognition
Use these Medicare G codes for certain services. Coders who want to remain up-to-date on ... Read more
Reader Question:
Leave Pain Dx Off Tendinitis Claim
Question: During the course of an evaluation and management (E/M) service for a new patien... Read more
Reader Question:
Stay on the Beat With Circadian Rhythm Disorder Dx Chops
Question: I just started working at a PM clinic that performs sleep studies, and trying to... Read more
Reader Question:
Push Pause, Count Minutes Before Coding Repeat Shot
Question: A patient with complex regional pain syndrome (CRPS) I in her arm receives a the... Read more
Reader Question:
Use External Cause Codes When Called For
Question: A 9-year-old was playing on the monkey bars at a local park when he fell and hur... Read more
Use This Advice to Dodge EP Study Denials
Length of latency can key code selection. If a patient reports to your PM specialist for ... Read more
Case Study Corner:
Check Chemodenervation Smarts With This Scenario
Can you crack this coding conundrum? Coders for PM specialists will almost certainly come... Read more
ICD-10 Coding:
Back Up Your Disc Disorder Coding With This Advice
If you don't know what myelopathy and radiculopathy are, here's why you should. Patients ... Read more
Clip and Save:
Check Out This Tx List for Cervical Disc Disorder Px
Diagnostic testing, therapy, medication, among the top PM encounters. If a patient has, o... Read more
Reader Question:
Get Specifics for Autonomic Agent Shots
Question: Notes indicate that the PM physician performed a single autonomic nerve injectio... Read more
Reader Question:
Forget Some Office E/M Rules on ED E/Ms
Question:  Our PM specialist was called to the ED to see an established patient for a... Read more
Reader Question:
Keep CRNAs Out of LT Lineup
Question: Can we code a certified registered nurse anesthetist's (CRNA) service with a loc... Read more
Reader Question:
HIPAA Mandates 50 Years of Privacy for Deceased Patients
Question: Per the Health Insurance Portability and Accountability Act (HIPAA), should we m... Read more
You Be the Coder:
CT Guidance and Epidural Claims
Question: Notes indicate that the PM specialist performed an interlaminar lumbar epidural ... Read more
CPT® Coding:
Keep Up With Payer Policies on Face/Neck Chemodenervation
Whether a Dx is acceptable for procedure could depend on payer. Patients who report to th... Read more
ICD-10 Coding:
Check Out 1 Payer's Face/Neck Chemodenervation Code List
Here's why you need to know every payer's policy on paying 64612-64617. Choosing an accep... Read more
2019 MPFS:
Get Ready in Case E/M Changes Go Through for 2019 Fee Schedule
Here's how these new CMS-proposed rules might affect your practice. Evaluation and manage... Read more
Get Back to the Basics to Master Critical Care
Here's the lowdown on coding for the critically ill or injured. If a PM specialist is cal... Read more
Reader Question:
Details Help You Decide Between Achilles, Peroneal Tendinitis
Question: What is the difference between Achilles tendinitis and peroneal tendinitis? And ... Read more
Reader Question:
Consider Migraines a Related Dx
Question:  Our provider diagnosed a patient with chronic migraines and headaches r/t ... Read more
Reader Question:
Stay Positive on Negative ROS Coding
Question:  Can we count a “complete” ROS when the surgeon includes a statement su... Read more
Reader Question:
Use These G Modifiers for ABN Success
Question: I'm filing a claim that includes an advance beneficiary notice (ABN) for a Medic... Read more
You Be the Coder:
Get All the Info You Can on 'Involuntary Movement' Dx
Question: After performing a level-three evaluation and management (E/M) service for a new... Read more
ICD-10 Coding:
Determine CTS, Ensure Pay for Future Treatments
Most insurers require a CTS diagnosis before approving therapeutic measures. When you are... Read more
News You Can Use:
Medicare Carrier Loosening Some NPP E/M Rules
NGS will allow NPPs to code same-day E/Ms under certain circumstances. If you've heard of... Read more
Insider Info:
Get the Lowdown on These Common Epidural Injection Questions
Should you be coding for drug supply on injections? Find out. Patients reporting to your ... Read more
ICD-10 2019:
Use New Codes for Exploitation, Abuse
There's a code set for cyberbullying in the new ICD-10. The ICD-10 2019 code book will in... Read more
Reader Question:
TTS: Like CTS, but Different
Question: A new coder in our department told us that her previous practice treated patient... Read more
Reader Question:
Here's the Real Guidelines for Coding Virtual Visits
Question: How do we document email exchanges between a patient's guardian and our PM speci... Read more
Reader Question:
CCI Knowledge Should Include Exclusive, Unlikely Edit Info
Question: What is the difference between mutually exclusive edits, and medically unlikely ... Read more
You Be the Coder:
Don't Double Dip on EEGs
Question: Notes indicate that the PM physician performed an extended electroencephalogram ... Read more
News You Can Use:
Here's the Good — and the Bad — of the 2019 MPFS Proposal
Conversion, flat E/M coding rates highlight CMS suggestions. CMS recently released its an... Read more
Keep an Eye on Notes for Sure-Shot Epidural Injection Coding
Reminder: Cervical/thoracic, lumbar/sacral shots have separate codes. PM coders that file... Read more
E/M Coding:
Get Rules Straight for Providers Using 99211
You can report this E/M without a physician present … sometimes. The established patien... Read more
Reader Question:
Look for Liquid Buildup on Effusion Patients
Question: Our PM specialist performed a level-three evaluation and management (E/M) servic... Read more
Reader Question:
Check Sequence When Coding for CT With Contrast
Question: Notes indicate that the PM specialist performed a computed tomography (CT) scan ... Read more
Reader Question:
Keep Your Finger on Digital Neuroplasty Code
Question: I'm new to PM coding and I've been trying to get up to speed on the CPT® codes ... Read more
You Be the Coder:
Arthrocentesis Coding With Depo-Medrol
Question: A patient with a diagnosis of post-traumatic right knee osteoarthritis reports t... Read more
ICD-10-CM Update:
Myalgia, Muscular Dystrophy Get Specific in 2019
Start using ICD-10-CM 2019 codes on October 1, 2018. The final list of ICD-10-CM codes fo... Read more
E/M Coding:
Solve These Subsequent Care Scenarios
Let our experts help you evaluate and manage service level determinations. When a provide... Read more
Follow This FAQ for Lowdown on MRIs
You need to consider anatomy, contrast material to nail these claims. Coding for your PM ... Read more
E/M Coding:
Note Clinical Staff Differences on Prolonged Services
Codes differ for certain providers when service is prolonged. When your PM practice sees ... Read more
Reader Question:
Employ Education to Cut PHI Breaches
Question: What can I do to make sure our practice stays current on best practices to avoid... Read more
Reader Question:
Stay on Beat with Rhythm EKGs
Question: I am unsure about some of the electrocardiogram (EKG or ECG) reporting rules. Co... Read more
Reader Question:
Choose TMJ Disorder Dx Carefully
Question: How should I report a diagnosis of temporomandibular joint (TMJ) disorder? Mont... Read more
You Be the Coder:
Ankle Pain Diagnosis Coding
Question: A patient reported to our practice complaining of pain in the right ankle region... Read more
Keep EDX Tips on Hand for Optimal Coding
Remember; NCS/EMG combo could spell electrodiagnostic test. One of the tests your PM prov... Read more
CPT® Coding:
Avert Arthrocentesis/Aspiration/Injection Denials with these Tips
Anatomy is crucial to coding these claims. PM practices that perform arthrocentesis, aspi... Read more
Recoup Unrelated E/M Pay with 24
Know surgical periods for services before considering modifier. How to use modifier 24 is... Read more
Case Study Corner:
Gain Modifier 24 Guidance Via this Scenario
Here's how unrelated E/Ms during postop periods can happen. It can be a little difficult ... Read more
Reader Question:
Separate Sequential, Concurrent IV Infusions
Question: What is the difference between an additional sequential intravenous (IV) infusio... Read more
Reader Question:
Use 'Other' Classification for this Spondylopathy
Question: The PM specialist performs a level-two evaluation and management (E/M) service f... Read more
Reader Question:
Know History for Accurate E/M Charts
Question: When coding a chart for an evaluation and management (E/M) service, how do we kn... Read more
You Be the Coder:
Coding for Concussions
Question: The PM specialist diagnoses a patient with a concussion. What is the best ICD-10... Read more
CPT® Coding:
Count Levels Before Taking Shot at these Facet Joint Injections
Cervical/thoracic, lumbar/sacral shots might be multi-code encounters. Patients reporting... Read more
Clip and Save:
Look to these Codes on Paravertebral Facet Joint Injections
Remember, not all payers have identical approved diagnoses. When a patient reports to the... Read more
Incident-to Savvy Can Boost Bottom Line
Medicare, some third-party payers will let NPP bill incident-to ... if rules are met. Pai... Read more
ICD-10 Coding:
Aim Straight on Stomach Pain Dx with these Tips
Supporting stomachache coding can be easy with the proper guidance. Patients reporting wi... Read more
Reader Question:
Remember Fracture History on Osteoporosis Dx
Question: The PM specialist treated a patient with osteoporosis. The patient doesn't have ... Read more
Reader Question:
Check Out these Knee-Related RA Codes
Question: I have encounter notes in front of me that indicate the provider treated a patie... Read more
You Be the Coder:
Go All the Way to 7 on Crush Injury Dx
Question: An established patient with an injured forearm reports to the PM specialist. The... Read more
CCI Edits:
Look for April Shower of CCI Bundle Changes
Care management, prolonged services get new edits. As of April 1, the latest version of t... Read more
Count Time, Px Status to Nail Sequela Coding
These guidelines can aid your sequela character selection. PM practices see their share o... Read more
Dodge HPI Pitfalls with this List of Truths
HPI's philosophy counts on SOCRATES. PM coders that get confused when coming up with a pa... Read more
Reader Question:
Note Student Rule Change on E/M Documentation
Question: Our physicians often complain about having to re-document the elements of evalua... Read more
Reader Question:
Modifiers 24, 25 Are (Sometimes) Compatible
Question: Can you ever report modifiers 24 and 25 on the same claim? Oregon Subscriber A... Read more
Reader Question:
CMS Trying to Make EHR Regs Simpler
Question: What do I need to know about the MyHealthEData initiative recently announced by ... Read more
You Be the Coder:
Get NPI Right on Incident-to E/M
Question: An established Medicare patient with a plan of care in place to treat a chronic ... Read more
Anatomy Keys Code Choice on Trigeminal, Occipital Nerve Blocks
Injection for lower jaw pain could be a TN block. When you're deciding which code to choo... Read more
Follow this FAQ Advice for ABN Success
ABN's your best friend if Medicare has a payment issue. If your practice is about to prov... Read more
E/M Coding:
Remember Different Payer Rules for Consults
Medicare doesn't recognize CPT® consult codes. When the PM specialist performs a consult... Read more
Reader Question:
Use Single Code for Joint Aspiration/Injection
Question: How do I code a scenario in which the provider performs a knee aspiration and th... Read more
Reader Question:
Count Extremities, Muscles Separately on Chemodenervation
Question: Encounter notes indicate that the PM physician performed a level-three evaluatio... Read more
Reader Question:
Take Right-Sided Pain Dx Coding to the Limit
Question: The PM specialist saw a new patient with a complaint of right-sided extremity pa... Read more
You Be the Coder:
Spinal RF Ablation Coding
Question: An established patient reports to the PM specialist for scheduled spinal radiofr... Read more
Terminology 101:
Take this Migraine Coding Advice, Strike Dx Gold
Knowing what indicates an 'aura' could solidify code choice. Patients who report to a PM ... Read more
Terminology 101, Session 2:
Add these Migraine Terms to Your Arsenal for Stronger Coding
Here's what defines an intractable migraine. There is language in the ICD-10 book that ca... Read more
E/M Coding:
Rely on ROS Smarts for Coding Acumen
Remember, ROS has 3 levels. The review of systems (ROS) is a key component to many evalua... Read more
Reader Question:
Get More Info for Evoked Potentials Code
Question: Notes indicate the PM physician performed an evoked potentials test. It was a sh... Read more
Reader Question:
Pay Attention to Detail for Limb Length Dx
Question: Notes indicate that the provider performed a level-three new patient evaluation ... Read more
Reader Question:
Find Injection/Infusion Evidence on Nerve Blocks
Question: After performing a level-four new patient evaluation and management (E/M) servic... Read more
Reader Question:
Pinpoint Px Condition with Anxiety/Depression Smarts
Question: Our PM physician treated a patient with insomnia and documented "anxiety depress... Read more
Reader Question:
Look for Previous Tx Evidence on CT Injections
Question: Three months ago, our provider saw a patient complaining of wrist pain, a burnin... Read more
You Be the Coder:
Remember, Different Types of Ab Pain Have Different Codes
Question: What is the correct ICD-10 code for upper-quadrant abdominal pain? Indiana Subs... Read more
Injection Coding:
Sharpen ICD-10 Smarts for Accurate TPI Coding
Drill down in notes, because there's no definitive list of TPI diagnoses. Patients in pai... Read more
Keep Locum Tenens Rules Handy for Fill-In Physicians
Replacement physicians often sub for providers on leave. Just about every PM practice has... Read more
News You Can Use:
HIPAA Clarification Aims to Stem Opioid Abuse
PHE stresses need for information-sharing knowledge. Recent federal determinations addres... Read more
Reader Question:
CMS Sets Out New Telehealth Guidance
Question: Can you tell me if there's anything new going on in telehealth coding for 2018? ... Read more
Reader Question:
Dodge High-Level Prolonged Services Myth
Question: Can you report prolonged services with any level of evaluation and management (E... Read more
Reader Question:
Heed this Advice for APN Coding
Question: We have two house-call teams of advanced practice nurses (APNs) who go to patien... Read more
Reader Question:
UHC Adds Modifier Requirement for these E/Ms
Question: Our practice has been told that there are new rules for nurse practitioners (NPs... Read more
You Be the Coder:
Choosing a Metatarsalgia Dx
Question: What are the ICD-10 options for reporting metatarsalgia? Florida Subscriber An... Read more
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