pain management

  1. J

    Wiki NJ/NY Providers billing issues (tax ID registered in NJ provider in NY)

    The practice I work for recently brought on a pain management MD who sees patients in NY. we have been having issues with BCBS specifically the out of state plans stating since the MD sees patients outside of NJ it needs to be submitted to the New York local and not our NJ local. Does anyone...
  2. R

    Wiki Migraine Nerve Block Injections

    Hi! My provider and I disagree with the proper codes for migraine/nerve block injections. One of us believes 64615 covers all of the below. The other thinks that there is money that could be left on the table. Could someone help settle this so we can properly code these charts, please? Below is...
  3. M

    Wiki CPT codes 20553 vs. 20552 cost error?

    Hi everyone! I just started coding a few months ago and I have a question pertaining to CPT codes. I’m coding trigger point injections for a pain management practice, and the 20552 code comes up as $650, while the 20553 code comes up as $250. Doesn’t this seem backwards? Why would less work...
  4. 5

    Wiki T12 thoracic vs L1 lumbar coding

    Hello, How do all you pain management coders code if the procedure was at the T12 - L1 site? Single injections If it is a ESI, would you use the Thoracic code of 62321? If it is a TESI would you use the thoracic code of 64479? What if the TESI was at the T12-L1 and L1-L2? If it is a facet or...
  5. C

    Wiki 2410 Loop Rejection

    Anytime I code a J3301 - Kenalog - injection with injection CPT it kicks back in the system stating a 2410 loop This is the rejection: 06/15/2022 view less Payer Rejected J3301 H MISSING OR INVALID INFORMATION. ADDITIONAL DETAILS WILL FOLLOW IF AVAILABLE (J3301) Missing or invalid...
  6. A


    We have been having an issue of getting our pain management injections paid by Optum Lifeprint (ex. ESI, MBB, RFA, Joint, etc). Everytime we bill an injection, we get a denial stating that Optum requires a drug code to be associated with the claim. And here is the kicker: we don't buy the drugs...
  7. I

    Wiki Rotor Study

    My provider is doing a "Rotor Study" (injecting contrast- flouro into the spinal pump to make sure its working properly). I have looked everywhere and still cant find an specific code that would best describe this procedure. Does anyone know if there is a code for this? if not, would the 64999...
  8. G

    Wiki Procedure code 64490 has not met the associated Code-to-Code relationship criteria for CMS ID(s) L34892

    "Per LCD or NCD guidelines, procedure code 64490 has not met the associated Code-to-Code relationship criteria for CMS ID(s) L34892" This is the denial received for an AARP Medicare Complete plan where we billed out: 99214-25 64490-50 DX code M47.812 Can someone explain this denial please? Is...
  9. K

    Wiki SCS Psych Eval

    A psych eval is required prior to an SCS Trial however, I can't seem to locate a policy (Medicare, Evicore, etc) that states a specific timeframe that this needs to be performed within/prior to surgery. Example: Patient has already had a psych eval for a previous procedure (>2 years), but...
  10. B

    Wiki VACCN

    When a VA pt comes into PAIN MANAGEMENT with an authorization for say Lumbar but then wants a Cervical region procedure, is there a primary dx code to use on the auth to cover the whole back instead of JUST one or the other causing more than one authorization?
  11. C

    Wiki Erector Spinae Plane Block

    Hi there- Does anyone know what CPT code should be used for a Erector Spinae Plane Block ? Everything I have found says to use the unlisted 64999. If anyone has any supporting documentation on this topic and would like to share that would be great. Thank you in advance.
  12. E

    Wiki HELP!! RFA/Facet block new LCD's as of 4-25-2021 Florida and Georgia

    Per LCD 33930 and 38765 Under limitations it states We have a 3 level unilateral lumbar RFA being denied due to LCD but from what I am reading we should be able to do a 3 level unilateral RFA. Help What is your interpretation of the LCDs and has anyone else encountered this issue?

    Wiki Medicare and 3rd level facet blocks

    Hi there, recently Medicare made it policy to deny 3rd level blocks. The LCD states they can be appealed upon denial, but I'm not sure when/why a 3rd level block would be medically necessary? What are grounds for appeal? Thanks for any help.
  14. C

    Wiki 27279 and 20931 denial

    Hello! I am new to a pain management office and have been going through denials that have gathered and noticed when 27279 and 20931 are being billed together, they almost always pay 27279 but will not pay 20931 stating you can not bill it separately. Has anyone had luck either adding a specific...
  15. M

    Wiki Pain management & Quantifying Multiple Chronic Illnesses of the Spine per 2021 E/M Guidelines

    I could really use some input/direction/help quantifying multiple chronic illnesses of the spine. Patient with chronic low back pain. Her pain is axial. It is muscular and related to severe scoliosis and degenerative changes. Would you consider this one chronic illness, low back pain or 2...

    Wiki Sacrococcygeal injection

    Using fluoro, my doc injected the sacrococcygeal joint with depomedrol/marcaine/contrast and wants to bill 20605. However, this cpt requires RT/LT. Any advice? This is for coccyx pain. TIA!
  17. S

    Wiki Pain Management Billing

    We are billing for a bilateral lumbar RFA for 3 levels and are having trouble getting the add on code to pay. It is 64635 Mod 50 and then since the add on code can no longer be coded with a mod 50 we have done 64636 with 4 separate line items (with no modifier) and it has denied. The 2021 CPT...
  18. V

    Wiki Therapeutic Wound Exploration and lysis of lumbar adhesions.

    Our pain management doctor performed a procedure which was authorized under CPT code 11043 - Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less. This is what the doctor documented: The patient was brought back into the...
  19. N

    Wiki Pre-Procedure Psychiatric Clearance Questions

    I work for a pain management doctor who is now performing procedures in office and also in an ASC that payers are beginning to require pre-procedure psych evaluation and clearance for. The physician would like to contract a LCSW to work in the office part time, under our group NPI, to perform...
  20. 5

    Wiki two speicalty providers same tax ID number

    Hello Can someone get back to me on how to bill two different specialty under same Tax ID number. I have incidents at the surgery center with when a CRNA and Pain specialty physician both provided services on the same patient on same day and one is getting denied. One is a anesthesia code and...
  21. 5

    Wiki down coding from 99214 to 99213

    Hello, Our provider feels his office visits support a 99214 due to pain management with patients that are being treated with pain meds. The patient has a work comp approved claim. The provider documentation has ROS of 7 systems, pain assessment with location, rating, description of pain...
  22. 5

    Wiki office visit with chronic pain management

    Hello, Our provider feels his office visits support a 99214 due to pain management with patients that are being treated with pain meds. The patient has a work comp approved claim. The provider documentation has ROS of 7 systems, pain assessment with location, rating, description of pain...
  23. S

    Wiki SIJ/Medial Cluneal Nerve Stimulator Coding

    My pain management provider coded this procedure with 64555-51 (2 units), 64575, 64590 (2 units). Medicare denied the last 2 codes. Are the codes included in the primary? DX code is G58.9. Can anyone clarify this? Thanks in advance!
  24. S

    Wiki Epidural Steroid Injections

    I am in an ASC. We have a doc who did epidural steroid injections in both the cervical and the thoracic regions (w/ fluoroscopic guidance). When I coded it I did 62321 and 62321-59 with different dx codes for each section, but the claim was rejected by Medicare (Palmetto) because the "the...
  25. P

    Wiki Caudal ESI with ultrsound guidance

    What is the correct way to code for a caudal ESI under ultrasound guidance? 62322 , 76942 or 62323? The current NCCI edits show 76942 to be a column two code for 62322 and a modifier is allowed. Does the "with imaging guidance" in 62323 include ultrasound? 62322- Injection(s) of diagnostic...
  26. J

    Wiki Third Occipital Nerve Block and Ablations

    I'm just curious how many people have had issues with providers and TON(third occipital nerve) blocks/ablations. I've found lots of documentation to support using 64490/64633 for the blocks and ablations that take place between the c2-c3 spine. My providers want to use the peripheral codes...
  27. B

    Wiki Using E/M codes or CC cpt with 36556 and 31500 for Medicare PROBLEM!

    Good evening! I am hoping for some help on this. I am billing for a pain management doctor/anesthesiologist that goes to the hospital and will see a patient earlier in the day (E/M Codes- 99233/99232/99223) and then insert a catheter (36556) later on in the day (or vice versa) OR he will do an...
  28. L

    Wiki Pain Management documentation

    I have a pain doctor that is wanting the M/A to type the radiology impression (findings) from another facility's radiology report on the patient's visit word for word, is this ok to do according to the standard documentation guidelines.
  29. A

    Wiki Virtual Reality Pain Management Reimbursement

    Does anyone have experience with Virtual Reality Pain Management billing/reimbursement? My clinic is thinking about possibly supplying Virtual Reality goggles for pain management and I am needing to know if this is worthwhile financially for the practice. Thanks, Ashley
  30. K

    Wiki Intrathecal Pain Pump Billing

    I need help, we are currently struggling to receive reimbursements from commercial payers and medicare. 1. Our commercial payers are denying our claims due to "exceeding max units allowed", but when converted to the appropriate units our units are accurate. 2. When commercial is primary and...
  31. S

    Wiki Sacroiliac Joint Radiofrequency Lesioning Coding Suggestions

    A provider performed a Sacroiliac Joint Radiofrequency Lesioning with Fluoroscopy. Medicare is denying the first two lines listed below as duplicate. Is this the appropriate way to code this procedure? Provider places the need in the joints then burns the needle. Any suggestions/thoughts...
  32. C

    Wiki Pain Mangement Billing

    Dr. X (pain management) is doing rounding on new patient pain consults for ABC Orthopedic Group. Is it possible to bill for Dr. X's rounding? They share the same tax id# and are different specialties. I know I have read it somewhere but can't remember where and now I need the info. Thank you!
  33. H

    Wiki EHR for Pain Management Practice

    Hi All, I work at a pain practice and the physician mainly does nerve blocks under ultrasound guidance and trigger point injections. We are looking for an EMR...FINALLY! :D Could you recommend systems for pain in particular? Thanks very much, Heather
  34. 5

    Wiki foreign body - surgical exploration

    The doctor did a surgical exploration of a painful foreign body which turned out to be an intrathecal pump connector which he removed and and then placed back into the wound. I am looking at 20520 or 20670 but am not sure either is accurate. Thank you for any assistance. PREOPERATIVE DIAGNOSIS...
  35. T

    Wiki MRI FUSION FOR PROSTATE BIOPSY in OFFICE question CPT billing-2 questions

    We perform MRI FUSION prostate biopsies in Office setting with a Radiologist that comes in 1x month bringing/using the MRI image disk and Fusion Program that we rent to use and pay him per patient. There is a question of the billing for this by our office. 1.We have been billing 55700...
  36. L

    Wiki Can a Cervical Tranforaminal injection be done with a catheter?

    I bill for a ASC and work with a doctor who has some confusing procedure notes at times. I want to know if you can use a catheter that has been threaded through the epidural space and then inject serveral formanina and bill it as multiple levels of a transforaminal injection (64479-64480). Any...
  37. J

    Wiki 64483 - 64484 Payer Denial

    Working in pain management. We bill the following combination often with no issue. However, an Arizona Medicaid plan is denying the 64483 and 64484 with "Procedure code inconsistent with modifier or required modifier is misssing". Upon query at the payer, they verified the modifiers submitted...
  38. J

    Wiki Trigger Point Injections specificity

    Is it necessary to list the specific names of the muscles injected, or can I bill based on the area of the muscle- for example, "Bilateral C2-3 paraspinous (1 cc x 2 injections), bilateral C6-7 paraspinous (3 cc x 2 injections), bilateral C7-T1 paraspinous (3 cc x 2 injections), bilateral T2-3...
  39. J

    Wiki Pre-Procedural Anxiety DX for Spinal Injections

    I code for a couple of anesthesiologists in a Pain Management practice who use sedation during epidural steroid injections, radiofrequencies, nerve root blocks, etc. to ensure that the patient's anxiety does not prevent them from correctly placing needles into the patient's spine. In order to...
  40. J

    Wiki 64479-64484 changes for 2011

    I noticed these codes were revised for 2011 to include "imaging guidance (fluoroscopy or CT) and contrast injection." Does this mean that we do not have to code the 77003 for a facility anymore? I am thinking not... but want to double check. Thanks for any help you might be able to provide.
  41. D

    Wiki discography work comp billing

    Does anyone out there do billing for discography for general work comp? If so what type of reimbursement do you get? We are an ASC, and I have a doctor who says that I am coding wrong, which I have researched until I am blue-in-the-face and have been told that I am coding correctly. We bill...
  42. V

    Wiki Pain Management OP Clinic

    a couple of my Anes Docs also run the Pain Mgt Clinic here at the hospital, place of service is 22. We have a PA who does Pain Pump Analyze, 62368 and Pump Refill, 95990. We keep getting a denial on 95990 not paid in place of service 22. Someone told us to try 96522 also a refill but we get...
  43. D

    Wiki cpt 64520 & 64640

    Is it correct to code cpt 64520 or 64640 twice on the same date of service for Medicare pts and for third party payors (mainly workers comp)? I have a doctor who says yes if he injected twice, it needs to be coded and billed twice. I recently went to a company sponsored seminar that said no...