Each clinical specialty has its own challenges and these days pain management practices have more than their fair share. Pain management is currently under the CMS microscope for what the government says is a high rate of incorrect coding and billing. Are you in line for an audit? New federal, state and private carrier guidelines for pain management could cost your practice money in denials, and even fines.
That’s where we come in. We know the complicated system of pain management billing and coding. For example, did you know?
- When performing bilateral procedures, always use Modifier -50, (it specifically represents a service or procedure that is performed on both sides of the body during the same session).
- Fluoroscopy cannot be billed separately on multiple occasions. It is declared included on the CPT on these separate occasions:
- Intraarticular joint or medial branch block facet joint procedure
- Radiofrequency ablation
- Keep implants in mind when negotiating payor contracts. You need to make sure that expensive implants are reflected in a competitive rate being paid to you by the payor.
At MICI we know how global days can affect relative treatment procedures, and the need to accurately code aspirations, injections, pain pumps and other treatment modalities. Our team knows what it takes to submit successful claims for complex procedures including:
- Diagnostic and Therapeutic Injections
- Facet Joint Procedures
- Nerve Block
Our expertise can make the difference between your practice making good money, or losing lots of it.
The Fine Complexities of Pain Management Billing
Evaluation and Management
When it comes to proper coding for evaluation and management (E/M) services, it may be a surprise at how much money is left on the table. Ask yourself the following questions:
- Have you assessed the importance of EM coding for your practice?
- Does your staff understand the fine points of key definitions that can impact the selection of EM codes?
- Can your staff identify the key components of EM and the documentation required to bill for them?
Another detail that can muddy the billing waters is workers’ compensation. It is a complicated, time-consuming process.
- Does your staff have to submit workers’ compensation claims for your patients?
- How does it interfere with their ability to properly code and bill for complex pain management procedures?
We know it is complicated. You are probably burned out from the administrative headaches of it all.
It’s time to call MICI. We will implement a comprehensive billing, coding and revenue management solution specifically for your pain management practice. We can make sure that every dollar you work for is accurately billed and appropriately reimbursed. You will be in good shape!