Improving Your Pain Management Collection

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Improving Your Pain Management Collection
American Academy of Pain Medicine estimates that
over 100 million people suffer from acute or
chronic pain, which equates to 20.4 or 1 in 5
adults. This number is far more than the number
of patients affected by heart disease, diabetes,
and cancer combined. While theres such growth in
pain management care, some of the pain management
billing and coding challenges make it difficult
to thrive. New state and federal regulations have
brought about some unique challenges to pain
management billing.   Recently pain management is
facing billing issues like expanding prior
authorization requirements, downward adjustments
to fee schedules, and shifting financial
responsibility to the patient. Once you
acknowledge and understand these challenges,
there are strategies to improve your pain
management collection.    Pain Management
Documentation (PMD)   Medical documentation
ensures the medical necessity of any procedure.
Similarly, pain management documentation (PMD) is
a critical element of pain management care. Its
a way to communicate about patients problems,
treatments, and responses among members of the
healthcare team. Complete and accurate pain
management documentation will avoid claim denials
due to missing or incomplete information.
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Improving Your Pain Management Collection
You have to document properly about laterality
or which nerves were treated. In the
documentation, the provider should include
thorough and accurate treatment information which
can be included in an operative note of the
addendum. Proper documentation allows the medical
coding team to choose accurate codes and they can
use correct modifiers whenever necessary. Medical
coders can code better if they refer to complete
documentation and not only a summary.    Payer
Policies and Guidelines   Every payer has its own
set of billing policies and guidelines. Most of
the commercial payers generally follow Medicare
guidelines but still, every payer customizes
their own billing guidelines. We have witnessed
major changes in payer policies and guidelines
during the corona pandemic and public emergency.
Every payer has responded differently in this
time. A good example has been the telehealth
changes that impacted patient E/M codes and
ICD-10-CM codes during this pandemic.   Staying
on top of payer policies and billing
guidelines will result in lesser denials and
quicker insurance reimbursements. In case of
confusion, picking up your phone and calling
insurance could provide better clarity and might
avoid delayed payments.
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Improving Your Pain Management Collection
Insurance companies on their websites and
provider portals constantly share updated billing
guidelines and policies. Training your coding and
billing team on these updates is a great way to
stay on top of payer policies and
guidelines.  Billing Fluoroscopy   Most of the
pain management practices often make the mistake
of billing fluoroscopy separately. Fluoroscopy is
actually included in many pain management codes
including discography, intraarticular joint or
medial branch block facet joint procedures,
transforaminal epidural steroid injections, and
radiofrequency ablations.   Be sure to understand
if this is a bundled charge for the procedure
used, i.e., SI joint (27096), medial branch
blocks, and facet injections, or is it recognized
separately, i.e., fluoro guidance codes for
peripheral joints. When you bill fluoroscopy
separately, your claims will get denied as a
duplicate claims.    Modifiers Modifiers help to
clarify the procedure in detail and the use of
the wrong modifier could result in claim denials.
Commonly used modifiers in pain management are as
follows
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Improving Your Pain Management Collection

• LT anatomically left-RT, anatomically right
• -50 bilateral
• -59 notes that a service or procedure is
  independent and separate from other services that
  were performed on that same day
• -52 incomplete procedure, stopping part of the
  procedure due to reasons other than patient
  well-being
• -53 incomplete procedure, the physician chooses
  to end a procedure for the patients well-being
• When you code for bilateral procedures, you have
  to use modifier -50. Modifier -50 specifically
  represents a procedure or service thats
  performed on both sides of the patients body
  during one session. Unfortunately, its a common
  mistake to forget modifier -50 or merely code
  each side of the body separately. 
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• Critical to the success of any pain management
  coding and billing program is avoiding anything
  that might trigger a post-service prepayment
  coding review from insurance payers.
  Insurance-mandated coding reviews can add up to
  180 days (or six months) to receiving payment.
  There is a solution to face these billing
  challenges by outsourcing your billing and coding
  functions to an expert medical billing company
  like Medical Billers and Coders.

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Improving Your Pain Management Collection
We ensure that proper codes are used to maximize
per code collection and reduce denials to keep
revenue flowing for your pain management
practice. Contact us today and find out how we
can help you grow your practice and improve
revenue with our services.