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Billing for Pain Management

  1. Question Billing for Pain Management
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    Our office recently opened up a pain management clinic in addition to our chiropractic clinic. As far as chiropractic, I am totally comfortable and capable of maximizing reimbursement for it. However, we've barely been breaking even when it comes to pain management. I admit my expertise is in chiropractic, but surely I have to be missing something. By the time we pay our MD and pay for supplies, there's really no money to be made. Is there something I can do as far as billing and coding to make this investment worth while? Any help at all would be soooo appreciated!

  2. #2
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    Tacoma, WA
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    1,087
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    Quote Originally Posted by MSimmons89 View Post
    Our office recently opened up a pain management clinic in addition to our chiropractic clinic. As far as chiropractic, I am totally comfortable and capable of maximizing reimbursement for it. However, we've barely been breaking even when it comes to pain management. I admit my expertise is in chiropractic, but surely I have to be missing something. By the time we pay our MD and pay for supplies, there's really no money to be made. Is there something I can do as far as billing and coding to make this investment worth while? Any help at all would be soooo appreciated!
    Actually a brief description of the type of services you are providing would be helpful in evaluating the situation. Pain management can encompass a lot of area, so if you are just providing specific services that may be the problem.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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    [SIZE="3"]Right now we are focusing on epidurals, nerve blocks, and facet joint injections. Soon we are going to be incorporating Nerve Frequency Ablation, which I know will increase revenue; but for now it is just breaking even. I wasn't sure if there was some coding that would make it more profitable or if the real focal point needs to be expanding our scope of pain management. Thanks for the reply![/SIZE]

  4. Default Oops...
    Wow, I meant Radio Frequency Ablation. Long day, haha.

  5. #5
    Location
    Columbia, MO
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    12,570
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    I think you are still going to need to elaborate. Can you give us a typical note for a visit? the assessment and the procedure and how it was billed?

    Debra A. Mitchell, MSPH, CPC-H

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    A sample procedure consists of an exam, usually a 99203 or 99204. We bill a lumbar epidural with a 62311 under fluoroscopy 77003. If we're able to, we will charge for the use of the epidural tray A4550 and sometimes we assist with trigger points, 20553. On average, we bill out about $1500-2000 a visit for a common procedure, but the reimbursement is sometimes only a quarter of that. For example, medicare only pays around $150 for a 62311 and that barely covers the supplies. I don't know if there are modifiers I can use or if those are "out of date" codes and there are newer ones that have a higher reimbursement.

  7. #7
    Location
    Columbia, MO
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    $150 for a 62311 is actually correct depending on your area, ours is around $123. for a 62311 and about $57 for a 20553, and around $60 for the 77003, and a 99204 goes for $153 so a visit for a new patient that then has an epidural for Medicare is going to get around
    $153 + $150 + 123 for a total of $426 for the visit. That is all that there can be and Medicare will pay 80% of that and the patient will pay the rest. I guess you may need to reevaluate your fee schedule to be more inline with what the payers are willing to pay, but $1500 to $2000 per encounter is quite high.

    Debra A. Mitchell, MSPH, CPC-H

  8. Default
    Quote Originally Posted by ajs View Post
    Actually a brief description of the type of services you are providing would be helpful in evaluating the situation. Pain management can encompass a lot of area, so if you are just providing specific services that may be the problem.
    i am taking my cpc exam next sat, the 10 but i have 2009 and 2010 bks is this ok since i dont have money to but the 2011 bks

    SAUKA

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