Improving Your Pain Management Collection

1
(No Transcript)
2
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.
3
Improving Your Pain Management Collection
Complete and accurate pain management
documentation will avoid claim denials due to
missing or incomplete information. 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
4
Improving Your Pain Management Collection
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. 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.
5
Improving Your Pain Management Collection

• 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
• -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 the modifier -50. Modifier -50
  specifically represents a procedure or service
  thats performed on both sides of the patients
  body during one session.  

6
Improving Your Pain Management Collection
Unfortunately, its a common mistake to forget
modifier -50 or merely code each side of the body
separately. 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. 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. FAQs 1. What is the
role of pain management documentation (PMD) in
billing and coding? Pain management
documentation is crucial for establishing the
medical necessity of procedures and preventing
claim denials. It ensures accurate coding and
helps avoid missing or incomplete information in
claims.
7
Improving Your Pain Management Collection
2. How do payer policies and guidelines affect
pain management billing? Each payer has unique
billing policies, and staying updated on these
guidelines reduces denials and accelerates
reimbursements. Regularly training your billing
team on these updates can help prevent payment
delays. 3. Why is billing fluoroscopy separately
a common mistake in pain management
practices? Fluoroscopy is often bundled with
certain pain management procedures, and billing
it separately can lead to duplicate claims.
Understanding which procedures include
fluoroscopy is key to correct billing. 4. How do
modifiers affect pain management
billing? Modifiers clarify procedures and ensure
accurate billing, helping to avoid denials. Using
the wrong modifier can result in claim rejection,
so its essential to apply the correct one for
bilateral or incomplete procedures. 5. How can
outsourcing billing and coding help pain
management practices? Outsourcing to an expert
billing company ensures correct coding, reduces
denials, and improves revenue collection. This
helps your practice avoid delays and maintain a
steady cash flow.