Wiki Pain Management in an Office vs In/Out Patient Hospital

[rwmmdj]

One of our physicians is interested in opening a pain management office, independant of our anesthesia practice. He will be billing POS 11-Office. I have expererience in billing PM in POS 22. I know, depending on the payer, I can bill supplies and drugs. What other differences can I expect?

 

[billingchic#1]

You can bill J codes for the steroids and other injectables. You cannot really bill for any other supplies. If they do not have a C-Arm in the office and will be doing injections at the hospital, just keep in mind to only bill the professional component (26 modifier) for any fluoroscopy used. The reimbursement is higher for POS 11.

 

[brockorama01]

Since you are performing procedures in an office setting you should always try to be reimbursed for supplies you pay for such as J3301, J1040, J0960, Q9966 (fluoro dye), A4550 surgical kit, A4208 for extra needles, 99070 for RF ground pads. For larger procedures you can bill for EKG monitoring and pulse ox.

Medicare and some payers consider the A codes global but everything else is reimbursed. NOTE: Reimbursement for drugs and supplies is generally low. A realistic goal is to simply break even.

I work with many pain physicians who work in an office setting very successfully.

Brock Berta, CPC-A, MBA
Billing Czar