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Pain Management Coding Alert

Needle Procedures:
Take This Advice on Decompression/Discography Differences
Remember; 1 is diagnostic, the other is corrective. Discography and disc decompression ar... Read more
Clip and Save:
Check Out these Dx Codes Related to Discography
Check with payers individually for approved, complete, Dx lists. When you're coding for d... Read more
News You Can Use:
CMS Looking to Close Tech Gaps With DPC
New pilot will zoom in on providers' access to data. The Centers for Medicare & Medic... Read more
E/M Coding:
ROS Can Be Easy As 1-2-3 With This FAQ
Put the elements on your side when reviewing ROS info. If you don't have a firm grasp on ... Read more
You Be the Coder:
Get Botox® Shots Right With Descriptor Smarts
Question: When our physicians administer Botox® for chronic migraines, we bill the HCPCS ... Read more
Reader Question:
Remember ‘Other’ Migraine Types
Question: I know all about your standard migraines, and I think I have a grip on how to re... Read more
Reader Question:
Check All Boxes Before Filing 95970 With E/M
Question: The provider saw a patient for an outpatient evaluation and management (E/M... Read more
Reader Question:
Ensure Safe Coding With This Middle-Day Advice
Question: How should I report an observation service that includes the following: On calen... Read more
Reader Question:
Tread Carefully on Chronic Vs. Acute Dx Question
Question: When should I code for an acute form of a condition as opposed to a chronic... Read more
CPT® 2020:
Several Injection Groups Shot Through With Changes
CPT® also deletes muscle testing codes. CPT® announced its official list of codes for 2... Read more
Nerve Blocks:
Keep Trigeminal, Occipital Blocks Separate
GON blocks = 64405. Some of the more common PM injections for patients with headaches and... Read more
News You Can Use:
Brush Up on Fee Schedule Specifics Before 2020
Anesthesia conversion factor remains virtually the same. Changes are coming to certain re... Read more
You Be the Coder:
Decipher This Blepharospasm Tx Scenario
Question: After a level-two evaluation and management (E/M) service for a new patient, the... Read more
Reader Question:
Use Correct Infusion Code or Risk Denial
Question: One of our providers performed an intravenous (IV) infusion for prophylaxis. Enc... Read more
Reader Question:
Keep 78, 79 Straight Using These Tips
Question: What is the difference between modifiers 78 and 79? Our PM physicians rarely per... Read more
Reader Question:
Use These Definitions of ‘Medically Necessary’
Question: Recently, our practice has had a couple of claims denied. The payers said t... Read more
Reader Question:
Don’t Let Time Slip Away on E/M Coding
Question: I'm confused about coding evaluation and management (E/M) services by time.... Read more
Reader Question:
Decipher Notes With Bilateral Synonym Smarts
Question: An established patient who has a temporomandibular joint (TMJ) disorder rep... Read more
CPT® 2020:
EEG, E/M Changes Are on the Horizon
EEG technologists get new codes. CPT® has released its final list of additions, deletion... Read more
E/M Coding:
Be Ready for Common Observation Scenarios
Remember the 8-hour rule for Medicare. When your provider performs an observation service... Read more
Modifier Madness:
Use 26 to Separate Codes, Affirm Correct Coding
Connect with TC provider on 26 claims to compare notes. Coders at PM practices will likel... Read more
Reader Question:
Drill Down for Pathological Fracture Dx
Question: If a patient suffers from age-related osteoporosis with a current pathological a... Read more
Reader Question:
‘Easy Bruising’ Leads to Difficulty Selecting Code
Question: Our provider recently mentioned “easy bruising” in his clinical notes. Is th... Read more
Reader Question:
Follow This Advice on Refill/MDM Decision
Question: Can you count a routine prescription refill as a moderate level of risk when det... Read more
You Be the Coder:
Brachial Plexus Block for Pain
Question: Our PM physician is treating a patient for postoperative pain after total should... Read more
Compliance News:
Medicare Examining Acupuncture Coverage
Proposal would allow for narrow-scope study. After all these years, there might have been... Read more
NCCI Edits:
New Nerve Destruction Codes Get Bundled Big Time
CCI tightens up coding loopholes with these HCPCS codes. The latest Correct Coding Initia... Read more
Mythbusters:
Get Your Info Right on ED E/Ms
Several factors make these codes different from office E/Ms. When you have to report your... Read more
You Be the Coder:
Test Postop Pain Coding Skills
Question: An orthopedic surgeon performs total knee replacement on a patient, and the... Read more
Reader Question:
Tread Carefully When Using These New Test Codes
Question: How should I report neuropsychological test adminis­tration and scoring wh... Read more
Reader Question:
Let Dictation Report Lead You to Diagnoses
Question: If you've got a report without a diagnosis that meets the CPT® code's Loca... Read more
Reader Question:
Parse Anatomy for Vertebral Disc Dx
Question: Notes indicate that the PM provider saw a patient recovering from a traumat... Read more
ICD-10 2020:
PM Practices Get a Few Additions, Revisions in New Code Set
Start knowing these codes now; only 4 months ‘til implementation! There's a new list of... Read more
CPT® 2021:
E/M Guidelines to Get More Structured
CPT® splitting guidelines 3 ways. Last month, we addressed some of the major change... Read more
E/M Coding:
Master 8 Elements of HPI, Sharpen Coding Skills
Use this chart to keep track of HPI details. When you are coding your provider's evaluati... Read more
Reader Question:
Don’t Confuse MRI With Magnetic Resonance Angiography
Question: What is the difference between a magnetic resonance imaging (MRI) test and a mag... Read more
Reader Question:
Separate Eye, Facial Pain With 2 Codes
Question: How would you diagnose orbital pain and facial pain in a patient? During a recen... Read more
Reader Question:
Don’t Get Confused With Bone Bruise
Question: After a level three evaluation and management (E/M) service for a new patient wi... Read more
Reader Question:
Seek Out Combo Codes When Possible
Question: A private payer has denied our claim for a pain management office visit for “m... Read more
You Be the Coder:
Coding Local Anesthetic Shots
Question: An established patient with a history of carpal tunnel syndrome (CTS) repor... Read more
Q&A:
Make Connection With Surgeon on Postop Pain Management
Note from surgeon requesting PM help is useful info. When your PM practice is charged wit... Read more
E/M Coding:
CPT® Panel Planning Big Changes for 2021 E/Ms
If you're fond of 99201, get ready to be heartbroken. Outpatient evaluation and managemen... Read more
Compliance:
Use These Pointers to Sharpen ABN Smarts
Remember modifiers, or payer might forget about ABN. At times, pain management practices ... Read more
Reader Question:
Reason for Infusion Helps Separate Codes
Question: Notes indicate that the physician provided 55 minutes of intravenous (IV) infusi... Read more
Reader Question:
Make Sure ESI Code Includes Proper Guidance
Question: What is the correct way to report a caudal epidural steroid injection (ESI) unde... Read more
Reader Question:
Get Specific With Chronic Pain Dx
Question: Encounter notes indicate that the provider treated a patient with “chronic pai... Read more
You Be the Coder:
Making Your Headache Diagnoses Count
Question: During a level-three evaluation and management (E/M) service for a new patient, ... Read more
Injections:
Use This Advice to Avoid TPI Misfires
Misreporting these shots could trigger an audit. Patients will often require trigger poin... Read more
Quick Facts:
Here’s What to Do About TPI Muscle Groups, Drug Supply
 You should be able to code separately for TPI drugs. In an effort to code as comple... Read more
E/M Coding:
Be Careful With ‘Counseling Exception’ E/Ms
It's tricky to code based on time. Have you ever chosen an evaluation and management serv... Read more
Reader Question:
Sort Myalgia Diagnoses From Fibromyalgia
Question: What is the difference between myalgia and fibromyalgia, and how do you choose a... Read more
Reader Question:
Get on Same Page As Auditors With Patient Status Rules
Question: Our practice was recently audited, and an established patient visit was marked a... Read more
Reader Question:
Do This to Keep Risk Calculations on the Level
Question: I'm trying to determine the level of risk in the following encounter: a patient ... Read more
Reader Question:
Getting Shin Splint Coding Right
Question: A new patient reported to the PM provider complaining of intense shin pain. Afte... Read more
Reader Question:
Remember: Different Infusions for Different Reasons
Question: Notes indicate that the physician provided 55 minutes of intravenous (IV) infusi... Read more
You Be the Coder:
Ask These Questions Before Choosing Unequal Limb Dx
Question: An established patient reports to the PM specialist for an evaluation and manage... Read more
Testing:
Get the Most Out of Stenosis Checks
Many times, providers go beyond E/M for confirmation. Patients who report to the PM physi... Read more
CPT® Coding:
Look to Injections, PT for Spinal Stenosis Tx Codes
PM provider not likely to perform surgical stenosis treatments. A PM physician will often... Read more
Compliance:
Avoid Auditors With These Coding Tips
An ounce of prevention can make audits less likely. To paraphrase Paul Revere, it looks a... Read more
Reader Question:
Avoid Working Overtime on OT Claims
Question: Is there a difference between coding for occupational therapy treatments an... Read more
Reader Question:
Make Sure External Morbidity Codes Are Secondary
Question: In the interests of painting the most complete diagnosis picture possible, our c... Read more
Reader Question:
Check Notes Carefully on Spinal CT Claims
Question: Encounter notes indicate that the provider performed a computed tomography (CT) ... Read more
Reader Question:
Keep Up With MBI Requirements for Medicare Px
Question: We have posted everything available from the Centers for Medicare and Medicaid S... Read more
You Be the Coder:
Keeping Up With ICD-10 Terminology
Question: After a level-two evaluation and management (E/M) service for a new patient, the... Read more
ICD-10 Coding:
Dig Into Notes to Strike Migraine Coding Gold
Most, but not all, migraine codes require a sixth character. A patient has a migraine hea... Read more
Q&A:
Stay Sharp With Trigger Point Documentation Smarts
Take this expert advice on what to include to cement your TPI claims. Coding for trigger ... Read more
Modifiers:
Make Friends With Modifier 25 to Stave Off Denials, Audits
Use these FAQs to get the lowdown on this much-used modifier. If you think your modifier ... Read more
Reader Question:
Lack of CC Can Cause Coding Confusion
Question: An established 66-year-old patient presented to our provider. She did not s... Read more
Reader Question:
Pain in the Neck? Use These ICD-10 Codes
Question: When a patient reports to the PM physician complaining of neck pain, what i... Read more
Reader Question:
Interpreter Won’t Always Mean More MDM Points
Question: We recently took on a new patient who is deaf. The patient came with a family me... Read more
Reader Question:
Use These Tips for Spontaneous Rupture Dx
Question: Notes indicate that the provider performed an evaluation and management (E/... Read more
Reader Question:
Check for Arthrography Before Choosing X-ray Code
Question: Notes indicate that the PM physician performed a knee X-ray along with an ankle ... Read more
Reader Question:
Make ESI Coding Easy With Add-on Smarts
Question: I have some questions about billing for epidural steroid injections (ESIs). Pati... Read more
Reader Question:
HIPAA Knows no Borders
Question: Our practice uses a small cloud services provider (CSP) based in Canada to store... Read more
You Be the Coder:
Answer Branch Question Before Choosing Destruction Code
Question: An established patient with trigeminal neuralgia reports to the PM physicia... Read more
Add-On Codes:
Use Add-Ons to Count EMG/NCS Combo
You'll need 2 codes, and 2 documented orders, for these tests. When your PM specialist pe... Read more
Modifier Madness:
Take this Advice on These ‘5-’ Modifiers for Coding Success
Here's a primer on 51, 54, 57. Have you ever had a claim come back because of the lack, o... Read more
E/M Coding:
Separate New/Established Patients With These Pointers
If you only know the 3-year rule, time to go back to school. One of the most prevalent my... Read more
Reader Question:
Complexity Drives Occupational Therapy Coding
Question: When one of our providers performs occupational therapy, how should I report the... Read more
Reader Question:
Get Anatomy Right on Finger Arthroplasties
Question: Notes indicate that the PM physician performed arthro­plasty of a patient's fin... Read more
Reader Question:
Check Trauma Status on Cuff Tear
Question: The provider performs a level-three evaluation and management (E/M) service for ... Read more
Reader Question:
Avoid Billing Workers’ Comp for Some E/Ms
Question: A 66-year-old Medicare patient came into our office after injuring an arm a... Read more
You Be the Coder:
Use Combination Codes When Applicable
Question: Notes indicate that the PM physician performed a short-latency somatosensory evo... Read more
2019 Fee Schedule:
CMS Taking Steps to Reduce Provider Paperwork Burden
‘Patients over Paperwork' gets serious in 2019. In 2017, CMS started its “Patients ov... Read more
ICD-10 Coding:
Notes Are Key to Limb Pain Dx That Won’t Leave You Hanging
Denials likely to head your way without detailed Dx. If a patient has pain in any limb ... Read more
E/M Coding:
Stay Sharp on PFSH to Master E/M History
PFSH rules dictate what constitutes each history element. Correctly documenting a patient... Read more
Reader Question:
Stay Abreast of New Codes
Question: After a level-three evaluation and management (E/M) service for a new patient, t... Read more
Reader Question:
Check for Laminectomy Before Making Catheter Code Choice
Question: How should I report a catheter implantation for long-term medication administrat... Read more
Reader Question:
Get Enough Consult Info to Discern Office From Inpatient
Question: What is the difference between an office consultation and an inpatient consultat... Read more
Reader Question:
Fatten Bottom Line With Streamlined Appeals Process
Question: We were a solo practice for about 15 years, and the founding physician's wife wa... Read more
Reader Question:
Count Body Parts on Muscle Testing
Question:  The PM specialist performs manual muscle testing on three muscles in a pat... Read more
You Be the Coder:
Try Coding This E/M + X-ray Scenario
Question: An established patient reports to the PM specialist complaining of severe rib pa... Read more