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Anesthesia Coding Alert

Scrutiny Heads-Up:

Interventional PM Procedures Move to OIG's Radar Screen

2008 Work Plan includes note of special interest to pain management If your physician provides interventional pain management services, watch for an auditor to visit your practice in 2008 -- because the Office of Inspector General (OIG) might come for a checkup. According to the OIG’s 2008 Work Plan, Medicare payments for interventional pain management procedures will be on the group’s radar screen. The Work Plan specifically states, "We will review Medicare payments for interventional pain management procedures." Here’s why: Interventional pain management procedures consist of minimally invasive procedures such as needle placement of medications in targeted areas, ablation of specifically targeted nerves and some surgical techniques. While interventional pain techniques can help physicians diagnose and treat chronic localized pain that doesn’t respond well to other treatments, the Social Security Act mandates that Medicare only pay for medically necessary services. In 2005, Medicare paid nearly $2 billion for interventional pain procedures, potentially leading to this review and determination of the appropriateness of payments. Translation: Medicare carriers possibly shouldn’t have paid for some of the services. Common interventional pain management services can include trigger point injections (20552, Injection[s]; single or multiple trigger point[s], one or two muscles; and 20553, … single or multiple trigger point[s], three or more muscles), facet injections (64470-64476) and epidural injections (such as 62311, Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]). Work with it: If your physician provides interventional pain management services, check out next month’s Anesthesia & Pain Management Coding Alert to be sure your coding and documentation are on the up-and-up.

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