Pain management coding is a specialized and highly complex endeavor that is vital to any medical practice. Essential in optimizing reimbursement and revenue, coding professionals must be up to date with all of the necessary requirements and coding changes that affect pain management services directly.
CMS, The Centers for Medicare and Medicaid Services, has released the 2015 CPT coding changes for pain management. Although Medicare will be flexible in their audits for the first year after ICD-10 implementation, the new codes which rely on increased specificity, terminology changes and definition changes, must be utilized and become rote in the medical practice to ensure ongoing accuracy and compliance. CMS lists some of the new codes that have been added, in addition to changes made, in explicit areas that are relevant to pain management such as:
- Joint Injection
- Aspiration codes
- Ultrasound guidance and needle placement
- Drug screening
There are substantial changes related to the use of modifier -59. CMS has created 4 new HCPCS modifiers to specify and define particulars of modifier -59. Modifier -59 has long been used as a catchall. According to the Centers for Medicare and Medicaid Services, modifier -59 has been the most widely utilized HCPCS modifier, being broadly applied. Some have associated the modifier with the intention to skirt the Correct Coding Initiative. CMS has noted that the modifier “is associated with considerable abuse and high levels of manual audit activity” leading to abuse, reviews, audits, appeals, and fraud. The 4 new HCPCS modifiers to be added as subsets to -59 include:
- XE to denote a separate encounter:
- XS specifying a separate structure
- XP to include a separate practitioner
- XU to describe an unusual, non-overlapping service
Modifier -59 will still be utilized for those procedures that have no determinate specifics, but CMS will have the option to require the addition of a more specific modifier. Overuse, or the inappropriate use, of modifier -59 will be cause for rejection and denial of claims.
2015 has also seen the end of the bundling codes that express multi-level pain related procedures. CMS will no longer pay on more than one code.
Changes to coding requirements present significant challenges for pain management services when initiating claims for reimbursement. These demands are one reason that more and more practices are choosing to outsource their medical coding needs. Certified, specially-trained medical coders are the practitioner’s best defense against audits, time consuming reviews, claim delays, denials, and penalties. Dedicated professional coders ease the stress of medical practices through delivering consistent and reliable services. Outsourcing medical coding services allow practitioners the ability to concentrate their efforts within their office environment as needed, due to the added pressures of increased documentation and reporting guidelines.