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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
Injections:
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
Modifiers:
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
FAQ:
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
Compliance:
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
ICD-10:
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
ICD-10:
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
Compliance:
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
Modifiers:
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
Testing:
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
MACRA:
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
Compliance:
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
Modifiers:
Ensure Your Portion of Pay with Modifier 26
Here’s when you might need this modifier. When a medical provider performs services... Read more
Compliance:
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
Telemedicine:
Use This Telemedicine Primer to Prep for Coding Opportunities
Include POS code 02 on your telemedicine claims. CPT®  2017 offers you severa... Read more
ICD-10:
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
ICD-10:
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
ICD-10:
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