1. A

    Medicare denial 64635 but payment allowed for 64636

    I'm scratching my head on this one. We have two instances were Medicare has denied CPT 64635 Destruction RFA due to "information submitted does not support this many/frequency of services". However, for these same claims they have paid the add on code of 64636. I simply do not understand this, I...
  2. baroquecoder

    Chronic pain management

    So a patient returns for followup of pain management; specifically lumbar radiculopathy. The patient is taking cyclobenzaprine and also tramadol prn. Each visit of course is a UDS to confirm compliance with the opioid agreement on file. How is this coded? Would it be a z02.83? I mean the...
  3. 5

    Implanted Intrathecal Pain Pump refills

    Hi, I work in the billing department of a pain management office. We are having issues with Blue Cross taking back money for J codes that are billed out when we refill the pumps. Does anyone out in our AAPC world have time to let me ask some questions about this? I was told that Morphine...
  4. A

    Anesthesic injection at hardware site - how to code??

    This is a new one for me. Looks like he's trying to verify the cause of the patient's pain. How would you code this? PROCEDURE: 1) Right L5 pedicle screw injection 2) Left L5 pedicle screw injection 3) Right S1 sacral screw injection 4) Left S1 sacral screw injection 5) Fluoroscopic needle...
  5. R

    Transforaminal Steroid Injection

    Hi I really just want to get some clarity on how you would code the add on code for reimbursement. Level- l34 45 5s1 Left side 64483 64484. Any help would be great!!!
  6. F

    IT Pump in abdomen 'flipped' - manual external manipulation under fluoro to correct

    What can I bill for the repositioning of the pump?? This was performed in the office. I'm fairly new to pain management billing but this seems like a rare situation! Any more experienced billers out there able to shed some light on this? Pt is a 72 year old female referred by Dr. X for 2nd...
  7. N

    E&M coding w/o diagnosis

    My physician documented in the assessment part of his note and billed a diagnosis of shoulder pain, however he also diagnosed osteoarthritis in his x-ray results. Since there is a definitive diagnosis, I know this should be replacing shoulder pain. If the note gets audited, will the pain dx be...
  8. C

    Federal BCBS rejecting 62323 and 62321

    We have been having issues all of 2017 with FEP denying 62323 and 62321. First for medical records, and then when we send them, that our providers are not eligble to perform the service. 62311 and 62310 we never had any issues with nor are we having any issues with any of our other injection...
  9. P

    Fluoro for Genicular RF (77002 and 64640)

    Hey all! We've been told that 77002 in 2017 is an add-on code that does not work with 64640 (genicular RF). How are others billing the imaging component for genicular radiofrequency ablations since imaging is still not bundled in with 64640? Thanks! Rose
  10. A

    Pain Management Psych Eval

    We would like to start doing psych evals on our pain patients that are receiving controlled RX's from us. My question is, which test do we use, how do I bill it, what CPT codes and ICD 10 codes will I need??? Completely new to doing this I'm not even sure where to start.
  11. M

    99144 Conscious Sedation in Pain Management Office

    Hello, I was wondering if someone can assist me in how to document for Conscious Sedation in an office setting for Pain Management. We currently just use something like "Per patient request, the patient was then administered 2 mL of 2 mg/2 mL midazolam IM by the nurse." I am received denials...
  12. K

    Emergency room visits using t sheet

    When a patient is evaluated in the ER and a T sheet is filled out by a ER nurse and she documents Right Ear Pain. The physician then comes in and evaluates the patient and diagnosis Acute Ear Pain, but does not use laterality ie Right or Left. Can the coding be done as Right ear pain...
  13. J

    What can Radiologist bill for Epidural done by another doctor in radiology office?

    Can anyone tell me what to bill for the radiologist when an outside physician uses the radiologists office to do an epidural injection? The radiologist is dictating a report documenting the fluoro used & needle placement. This is the documentation from 2 different reports: EPIDURAL CLINICAL...
  14. T

    level 2 or 3??

    I am only getting a level 2 out of this??? what are everyone's thought of this?? am I missing something to make it a level 3??? I only see 3 elements on the hpi I got expanded HISTORY complete ros I got a DETAILED EXAM complete pfsh...
  15. K

    Remote Coder Needed for Pain Management

    Opening for a Full Time Remote Coder for a busy Pain Management Practice. Must be Certified Professional Coder and ICD-10 Proficient. Pain Management Experience is a Plus as well as Experience with Clinix EMR. If interested, email your resume to
  16. T

    sequela of fracture or pain code?

    I'm uncertain whether to code sequela of fracture or just pain code (provider's dx) for this encounter. Does the provider need to clearly state that the pain is a result of an injury to use the sequela code, or is the information below enough to support that it is (or am I making an assumption)...
  17. N

    what code for muscle spasm of neck

    which code would you use for: 1) muscle spasm of neck M62.838 other muscle spasm m62.48 contracture of muscle , other site 2) suprapubic abdominal pain be? R10.2 thanks much appreciated
  18. J

    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...
  19. T

    Wiki External cause codes

    Good Afternoon, My question is what is the proper way to handle and code no known injury. I was under the impression you had to have 3 external cause codes on any and every accident or injury. For example we see stuff like this all of the time. Wrist pain, no known injury My ankle has been...
  20. B

    Tongue and Gum Pain Injections?

    Medicare patient came in with burning mouth syndrome and pain provider did a pain injection in both the tongue and gum. Has anyone ever coded for this before? Could you offer any advice? Thanks in advance!
  21. M

    2nd Trimester Pregnancy

    Hi! I have a note for a patient who was seen in the ER for severe abdominal pain. I am wondering what category I should look under since it isn't Z3A (weeks of gestation) or Z34 (supervision of pregnancy). Do I code it as pregnant state, incidental? The diagnoses listed are RUQ abdominal pain...
  22. T

    can we bill an office visit with the injection??

    Chief Complaints: 1. Bilateral hip. HPI: Appointment type: Established patient - Established problem Patient returns for the MRI results of both hips. She denies any other complaints . ROS: Unchanged from 12/16/2015. Medical History: Infection, headaches...
  23. T

    can we charge office visit with the injection???

    can we charge the office visit with the injection?? please any help appreciated. Chief Complaints: 1. Bilateral hip. HPI: Appointment type: Established patient - Established problem Patient returns for the MRI results of both hips. She denies any other complaints ...
  24. S

    Hardware removal after fracture

    Just verifying one more time! If patient is having hardware from ORIF removed, I'm just going to use Z47.2 and no fracture code, right? Patient is not having complications or pain. Thanks!
  25. G

    knee "popped"

    Is this coded chronic or acute? Ex: A patient's knee popped while walking. Now he is in pain. He is coming to our facility for an MRI. Thanks
  26. T

    back pain with radiculopathy

    Can I code m54.16 and m54.5 together? M54.16 radiculopathy lumbar region M54.5 Low back pain
  27. D

    Coding of Rotator Cuff Tear

    If a patient presents with Shoulder pain and after exam the doc diagnoses the patient with a Rotator Cuff Tear but the patient did not sustain an injury and no prior shoulder surgery or pain, would this be billed with an M code or S code? I was thinking S code but there I am not able to provide...
  28. J

    URGENT - Anesthesia Coders and Quality Reviewers Needed

    Anesthesia and Pain Management Coders Needed (REMOTE) Aviacode is looking for coders and quality review experts experienced in anesthesia and/or pain management with at least 2 years experience (required) and that can commit a minimum of 20 hours a week. If you are interested please see job...
  29. N

    Compression Fracture- Initial or subsequent or Sequelae

    If an dr mentions that pt has osteoporosis with a compression fracture of the L-4 and L-5. Pt is on Boniva and goes to PT for chronic low back pain..... What is the correct code for the compression fx? The doctor doesn't seem to me as doing active txt.... This is not a healed old fx.
  30. J

    Coding ultrasound guidance when used for mode of anesthesia block?

    Hi there, I have a provider that is questioning if he can bill for the USG when he uses it to place an axillary block (or other blocks) that is being used as the mode of anesthesia and NOT post op pain management. Any help or reference on the subject would be greatly appreciated. Thank you.
  31. M

    E/M Level 3 or 4 (Hernia)

    I'm having trouble determining the level for this New Patient. The HX & PE are Comprehensive, but I'm stuck on the MDM. This is the A&P: "I discussed that though he has point tenderness to the area, no obvious fascial defect is palpated in the area. I recommend a CT abd/pelvis to better...
  32. T

    Hardware pain with healed fracture

    I had a patient come back to clinic 10 months after ankle fracture with pain. The fracture is now healed and the Dr. dx the patient with hardware pain. Question do I code T84.84xA (initial hardware pain) and S82.841S (Bimal ankle fx that was the cause of the hardware)? Or do I just code the...
  33. M

    Need help for a diagnosis of "Trauma. Pain."

    Can someone respond who can support their recommendation on this question? I need the diagnosis for this lumbar x-ray, there were no findings, it was a normal L-spine. The reason for the exam is documented as "Trauma. Pain." The patient had other films done that day (shoulder, arm, hip...
  34. P

    Iv infusion 96360

    I have been told that code 96360 for 1st hour of fluids includes first bag of fluids j7070. Is this true? Or is this for just the administration of fluids? Please advise.
  35. V

    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...
  36. T

    Billing for IV Push in Preop/Recovery

    If there is anyone who codes for ambulatory surgery I am having a problem. I have been told that when drugs are administered by our nurses in preop or recovery for anxiety or for pain control that the drug can be billed but not the administration of it. Does anyone know?