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Pain Management Coding Alert

E/M Coding:
Note Descriptor Updates when Coding Observations
Language change ends outpatient confusion on 99217-99220. Coding for observation services... Read more
E/M Coding:
Use this Advice for 'Middle-Day' Observation Coding
Rely on 99224-99226 if observation stretches to second full day without admit. On occasio... Read more
Case Study Corner:
Study Scenarios, Sharpen Disc Decompression, Discography Coding
Tip: Decompressions can include 2 codes. Last month, we took a tour of the coding convent... Read more
Reader Question:
Keep Track of Your Local RAC
Question: I've been doing some reading about recovery audit contractors (RACs), and frankl... Read more
Reader Question:
Stay Aware of Occipital Nerve Block Options
Question: Our provider administered a block near the skull base to treat occipital nerve p... Read more
Reader Question:
Use 57 when E/M Leads to 'Major' Surgery
Question: When are you supposed to report modifier 57? Is it a modifier for evaluation and... Read more
Reader Question:
Check Out How to Decipher CCI Modifier Indicator 1
Question: I was looking up Correct Coding Initiative (CCI) edits for 99221 and 99212, and ... Read more
Reader Question:
Start at Federal Level for IT Training
Question: I am the head of the coding department at a practice that has been under the sam... Read more
You Be the Coder:
Note Differences Between Muscle, ROM Tests
Question: Our practice recently began performing muscle and range of motion (ROM) testing.... Read more
Procedure Coding:
Know Discography, Decompression Differences for Coding Success
Remember, injection for discography is diagnostic, and a decompression is therapeutic. Pa... Read more
Inside the Notes:
Prove Prior Treatment, Proper Dx for Discography
Remember to check with your payer for official ICD-10 list. When reporting discography pr... Read more
Transitional Care:
Use these Tips to Avoid TCM Coding Traps
Observe the 30-day TCM period before reporting 99495, 99496. When you're reporting transi... Read more
Reader Question:
Dig Deeper for Ab Tenderness Specifics
Question: A new patient reports to the PM specialist complaining of pain in his lower... Read more
Reader Question:
3-Year Rule Tops New/Established Px Concerns
Question: What is the difference between a new and established patient when reporting... Read more
You Be the Coder:
Counting Monitoring Time on Extended EEG
Question: I have an encounter form that states the PM provider performed and electroe... Read more
Get Dx Right, and Then Take Aim at CTS Shot Coding
You might need a CTS diagnosis for 20526. But then again, .... Reporting therapeutic inje... Read more
Clip and Save:
Keep Drug Amounts Correct for Accurate Coding
The provider could use several different drugs during 20526 injection. Coders need to be ... Read more
Sharpen Modifier 25 Smarts with this FAQ
Remember to use 25 for E/Ms only ... never procedures. When it comes to a coding principl... Read more
Case Study Corner:
Check Out These Modifier 25 Coding Scenarios
Cases paint pics of 2 common modifier 25 encounters. While individual cases vary, most mo... Read more
Reader Question:
Avoid Reporting Prolonged E/M Codes with ED Codes
Question: Is there any way to report prolonged evaluation and management (E/M) servic... Read more
You Be the Coder:
Know Chronic, Aura Definitions for Accurate Migraine Coding
Question: Notes indicate that the clinician performed a bilateral Botox A (onabotulin... Read more
ICD-10 2018:
New Manual Rolls Out Expanded Spinal Stenosis Dx Group
Here's why neurogenic claudication knowledge will soon be vital. The World Health Organiz... Read more
Wake Up to Sleep Apnea ICD-10 Choices
Is the apnea obstructive? You'll need to know for proper code choice. When a patient repo... Read more
News You Can Use:
Medicare Set to Up 2018 Conversion Rate — but Slightly
Here's why this increase won't bump up your bottom line much. Coders hoping for a big hik... Read more
BCBS Carrier Cuts Modifier 25 Coverage
Experts call Independence's new ruling 'absurd,' 'awful.' Pain management practices typic... Read more
Reader Question:
Make G Modifiers Your Companion for ABN Claims
Question: I am new to coding for Medicare beneficiaries, and I'm still trying to mast... Read more
Reader Question:
Spot Shot Site Before Coding Morton's Neuroma Injection
Question: I have a puzzling claim in front of me. Notes indicate that the provider pe... Read more
Reader Question:
Use 'Substitute' Guidelines for LT Billing
Question: One of our physicians is going on vacation next month, and we are hiring a ... Read more
You Be the Coder:
Use Unspecified Code when Laterality's Nonspecific
Question: During the course of a level-four evaluation and management (E/M) service f... Read more
Substance Abuse Codes Strive for Specificity in 2018
New ICD-10 allows you to specify patient’s stage of remission. There’s a new ... Read more
Check Out these New PM-Related Code Additions, Revisions
ICD-10 gives primary lateral sclerosis its own code. PM coders will have to wrangle with ... Read more
CPT® Coding:
Connect Procedure with Concrete Evidence for Unlisted Coding Success
Insurer might have specific rules on documenting unlisted claims. There’s a very go... Read more
New Study Shows Staggering Amount of Miscoded 99215s
Practices were overreporting these E/Ms more than half the time. Check out what a recent ... Read more
Reader Question:
Use these Tips for CCM, Complex CCM Differentiation
Question: We have been struggling with coding for our patients who require chronic ca... Read more
Reader Question:
Throw the (CPT®) Book at Team Conference Claims
Question: Could you give me some insight into medical team conference code 99366? We ... Read more
Reader Question:
Be Sure You're Using Modifier 24 at the Right Time
Question: A patient developed a post-op infection during the global period of a surge... Read more
You Be the Coder:
Counting, Separating Nerve Conduction Studies
Question: I need help with this nerve conduction study (NCS) claim: Notes indicate th... Read more
Drug Coding:
Prevent Botox A Headaches with this Exclusive Advice
PM practices might use Botox A to treat several conditions. When you think of Botox, you... Read more
Get Some Botox Bucks Back with JW
When you throw Botox A away, try to recoup cost with modifier. If you aren’t using ... Read more
ICD-10 Coding:
Follow this Advice, Get a Leg Up on Limb Pain Coding
ICD-10 presents chance for greater specificity on extremity pain. Coding for limb pain wh... Read more
Reader Question:
Wring Out Encounter Notes for Wry Neck Proof
Question: A new patient reported to the practice complaining of neck pain. After an e... Read more
Reader Question:
Time-Dominant E/Ms Could Qualify for Counseling Exception
Question: Could you explain the counseling exception, and how it relates to office ev... Read more
Reader Question:
Remember Different Rules for Incident-to, Split/Shared Visits
Question: Can you please explain the difference between a split/shared evaluation and... Read more
Reader Question:
Report MIPS Measures Per This Advice
Question: I know that the four quality reporting measures for the Merit-Based Incenti... Read more
You Be the Coder:
Coding Multiple Nerve Blocks
Question: My physician performed three bilateral nerve blocks: a lesser occipital ner... Read more
Max Out Pay with Evoked Potential Study Smarts
CTS, ALS, MG patients often need short-latency studies. Coders should hold onto any evoke... Read more
Get Used to New Quality Reporting Measures Now
As PQRS exits the stage, MIPS makes its debut. Despite assumptions to the contrary, the e... Read more
ABN Update Adds New Language to Document
In June, you should start using a slightly different ABN. If you haven’t already ch... Read more
Reader Question:
Choose This Diagnosis Code for Mixed CP
Question: Our physician treated a patient in the observation unit of the local hospit... Read more
Reader Question:
Yes, You Can (Sometimes) Report Pre-EEG E/M
Question: If our physician performs an E/M service and then performs an electroenceph... Read more
Reader Question:
If You Code 99221/99238 Combo, Expect Trouble
Question: Can you ever report 99221 and 99238 on the same day under for the same pati... Read more
You Be the Coder:
Know Patient's Dominant Hand to Nail Hemiplegia Dx
Question: The physician performs a level-three evaluation and management (E/M) servic... Read more
E/M Coding:
NGS About to Up Some E/M Demands
Detailed exams are about to level up. Recently, the Medicare Administrator Contractor (MA... Read more
Postoperative Care:
Zero in on These Postop Pain Management Points
Documentation always helps postop pain reimbursement chances. If a surgeon places your pr... Read more
Ask an Expert:
Special Situations Dictate XP, XU Encounters
Here’s why you shouldn’t be using these modifiers regularly. While CPT® s... Read more
Reader Question:
Use Z Codes as Primary Dx ... Sparingly
Question: OK, settle a debate we’ve been having in the coding office. Some code... Read more
Reader Question:
Use Modifier 52 with Incomplete EEG
Question: One of our physicians performed an electroencephalogram (EEG) video monitor... Read more
Reader Question:
Call on These Pointers to Ace Phone E/Ms
Question: Can you explain when I can correctly report telephone evaluation and management ... Read more
Reader Question:
Put Focus on Patient with Digital Coms
Question: We want to improve our practice website so it’s easier for our curren... Read more
Reader Question:
Weigh the Good, and the Bad, of Patient Engagement Technology
Question: We’re starting to use more technology and online tools to engage our ... Read more
Reader Question:
Steer Clear of Billing IM Injection with Additional Pain Meds
Question: We have a physician who wants us to bill separately for an IM injection wit... Read more
You Be the Coder:
Consider Patient Details When Choosing Falling Dx
Question: When our practice treats patients with a history of falling, what ICD-10 co... Read more
Ensure Your Portion of Pay with Modifier 26
Here’s when you might need this modifier. When a medical provider performs services... Read more
New Benchmarks Help Explain Some Hospital Denials
Level 3 codes are under new payer scrutiny. If you have ever wondered how your practice&r... Read more
E/M Coding:
Put Some E/M Coding Questions to Rest with PFSH Knowledge
This history component is often vital to choosing the correct E/M code. If you occasional... Read more
Reader Question:
Add Injections on Arthrocentesis
Question:  When our physician performed arthrocentesis of the left shoulder, he perfo... Read more
Reader Question:
Avoid Coding IM Injection with Additional Pain Meds
Question: We have a provider who wants us to bill separately for an IM injection with... Read more
Reader Question:
Remember to Forget 77003 for Fluoroscopy
Question:  How can we report fluoroscopic guidance with epidural injections in 2017? ... Read more
You Be the Coder:
ICD-10 and Neck Sprains
Question: Our provider recently provided an evaluation and management (E/M) service t... Read more
CCI Update:
Note TPI Bundles, Moderate Sedation Mixup in New Edits
Getting denials for new sedation codes? This could be why. On January 1, the latest Co... Read more
Use This Telemedicine Primer to Prep for Coding Opportunities
Include POS code 02 on your telemedicine claims. CPT®  2017 offers you severa... Read more
Check Out This Dx Class for Stroke Scale Scores
ICD-10 codes include 42 NIHSS-related codes. ICD-10 2017’s arrival made coding f... Read more
Reader Question:
Code Non-Surgical Services for Recovering Surgery Patients
Question: One of our patients underwent emergency appendectomy surgery at the local... Read more
Reader Question:
Report 99291 for 1 Hour of Critical Care
Question: If the physician meets the requirements for critical care and has spent one... Read more
Reader Question:
Remember, Face-to-Face Evidence Necessary for 99217
Question: The physician meets an established patient at the hospital at 9 p.m. Thur... Read more
Reader Question:
Use 1 Set of Guidelines Per Claim
Question: I’ve heard that I can choose either the 1995 or the 1997 documentat... Read more
You Be the Coder:
Drug Supply and TPIs
Question: Our provider performed significant, separately identifiable level-three e... Read more
Procedure Coding:
Check Both Sides on Chemodenervation Claims
Sometimes, you need modifier 50 to make that claim fly. Coding for your physician's chemo... Read more
Hospital Coding:
File This FAQ Under ED E/M Coding
Remember, new and established patients are the same in the ED. Filing evaluation and mana... Read more
Up Your Focus on Post-Grace Period Denials
Getting denials based on Dx specificity? We've got the solution. Practices that haven't a... Read more
Follow These Steps to Master Cranial Nerve Neoplasm Coding
Here’s why you can’t always rely on nerve-specific ICD-10s. Choosing a dia... Read more
Reader Question:
Answer Occipital/Trigeminal Question on Nerve Injections
Question: How do I code for anesthetic injections into the greater occipital nerve ... Read more
Reader Question:
Use Initial Inpatient Codes Sparingly
Question: Can you use inpatient initial care codes 99221-99223 more than once in th... Read more
You Be the Coder:
Focal, Diffuse TBI Differences
Question: Our physician recently performed an evaluation and management (E/M) servi... Read more
CPT® Update:
Don't Sleep on New Moderate Sedation Codes
Remember 99143-99145? You can forget them. Another year, another set of new, revised a... Read more
ICD-10 Coding:
Start at R10 for Abdominal Pain Diagnoses
Here’s why you must know the difference between generalized pain, tenderness. Ch... Read more
Procedure Coding:
Code Chemodenervation After Patient Condition Check
CPT®, insurer policy can show you acceptable Dx codes. When a patient is suffering... Read more
Reader Question:
Count Duration Among HPI Elements … Usually
Question: An established patient reports to the physician with a chief complaint of... Read more
Reader Question:
Modify CLIA-Waived Claims for Coding Success
Question: How often must you update the review of systems [ROS] for a patient? With... Read more
Reader Question:
Green Light G Modifier for ABN Claims
Question: When should the practice get a signed advance beneficiary notice (ABN), a... Read more
Reader Question:
Provider Should Update ROS with Each Review
Question: How often must you update the review of systems [ROS] for a patient? With... Read more
You Be the Coder:
TPIs for Myofascial Pain Syndrome
Question: A patient with chronic myofascial pain syndrome presents for trigger poin... Read more