Pain Management Coding

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Pain Management Coding

• Princess Padilla CCS CPC CANPC COSC

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Pain Management Procedures

• Injections
• Destruction by Neurolytic Agent
• Intrathecal Catheters with Subcutaneous Pump
  Delivery Systems
• Spinal Neurostimulators
• Epidural Neurolysis
• IDET Intradiscal Electrothermal Therapy

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Steps to Pain Coding

• Know the approach
• Epidural
• Transforaminal
• Facet
• Know the type of injection
• Anesthetic
• Steroid
• Neurolytic agent

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Steps to Pain Coding

• Know the regions treated
• Regions cervical
• thoracic
• lumbar
• sacral
• Know the levels treated
• One or Multiple

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Steps to Pain Coding

• Know the injection restrictions
• Unilateral or Bilateral
• Know when fluoroscopy/ultrasound guidance
  reporting is allowable
• Know the global days

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Anatomy of Spinal Cord

• Covered by 3 layers of protective membranes
• Outside to Inside
• Dura Mater
• Arachnoid Mater
• Pia Mater

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Anatomy of Spinal Cord

• Epidural located over or upon dura mater
• Subdural Beneath the dura mater
• Subarachnoid Beneath the arachnoid mater
• Intrathecal
• intra within on inside
• thecal of relating to a sheath

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INJECTIONS

• Epidural injections
• The approach for an epidural injection is
  directly into the epidural space between
  vertebrae. The purpose is to relieve cervical or
  neck pain thoracic or midback pain lumbar or
  low back pain.

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Epidural Injections

• AKA Interlaminar, Interlaminar epidural, ESI,
  Translaminar Epidural,
• Standard Epidural
• CPT CODES 62310 62319
• v Imaging
• X Bilateral
• X Multi - level

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Epidural Injections

• Block VS Indwelling
• 01996 Daily hospital management of epidural or
  subarachnoid continuous drug administration

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Nerve Anesthetic Blocks

• (Nerve blocks) may be reported on the date of
  surgery if performed for postoperative pain
  management.
• Nerve block codes should not be reported
  separately on the same date of service as a
  surgical procedure if used as the primary
  anesthetic technique or as a supplement to the
  primary anesthetic technique.

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Nerve Anesthetic Blocks

• Modifier 59 may be utilized to indicate that a
  nerve block injection was performed for
  postoperative pain management, rather than
  intraoperative anesthesia, and a procedure note
  should be included in the medical record.

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Nerve Anesthetic Blocks

• AKA Nerve Blocks
• CPT CODES 64400-64530
• v Imaging
• v Bilateral
• v Multi - level

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Transforaminal Injections

• The approach for a transforaminal injection is by
  way of the intervertebral foramen. There are two
  foramen for each vertebra on opposite sides of
  the spine.
• The needle is inserted to gain access to the
  epidural space and nerve root.

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Transforaminal Injections

• AKA Steroid Anesthetic Agent Transforaminal
  Epidural
• CPT CODES 64479 64484
• X Imaging
• v Bilateral
• v Multi level

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Facet Joint Injection

• AKA Paravertebral Spinal Nerve Medial Branch
  Nerve Facet Joint Nerve Injections
• CPT 64490 64495
• X Imaging
• v Bilateral
• v Multi level

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Destruction by Neurolytic Agent

• Radiofrequency ablation procedures are reported
  with the appropriate destruction codes. CPT
  64600 - 64636
• Includes
• chemical e.g. Phenol, Alcohol
• thermal
• electrical
• radiofrequency

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Destruction by Neurolytic Agent

• X Imaging
• v Bilateral
• v Multi level

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Chemodenervation Injections

• Chemodenervation of muscles in the face, neck,
  extremity(s) and/or trunk.
• These services may involve injections of single
  muscle groups or multiple muscle groups.

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Chemodenervation Injections

• AKA BOTOX injection
• CPT CODES 64611-64614
• v X Imaging
• v X Bilateral
• v X Multi level

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Injection Documentation

• Each Level in title and verbiage of report
• Image guidance used and image kept
• Needle placement based on image
• where it entered
• Where the medications are going

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Sources

• ASA Relative Value Guide
• AMA CPT
• 2012 Coding Changes for Pain Management Marvel
  Hammer RN CPC