2 Pain Management Procedures InjectionsDestruction by Neurolytic AgentIntrathecal Catheters with Subcutaneous Pump Delivery SystemsSpinal NeurostimulatorsEpidural NeurolysisIDET – Intradiscal Electrothermal Therapy
3 Steps to Pain Coding Know the approach Epidural Transforaminal Facet • Know the type of injectionAnestheticSteroidNeurolytic agent
4 Steps to Pain Coding Know the regions treated Regions: cervical thoraciclumbarsacralKnow the levels treatedOne or Multiple
5 Steps to Pain Coding Know the injection restrictions Unilateral or BilateralKnow when fluoroscopy/ultrasound guidance reporting is allowableKnow the global days
6 Anatomy of Spinal Cord Covered by 3 layers of protective membranes: Outside to Inside:Dura MaterArachnoid MaterPia Mater
7 Anatomy of Spinal Cord Epidural – located over or upon dura mater Subdural – Beneath the dura materSubarachnoid – Beneath the arachnoid materIntrathecal –intra “within on inside”;thecal of relating to a sheath
8 INJECTIONS Epidural injections The approach for an epidural injection is directly into the epidural space between vertebrae. The purpose is to relieve cervical or neck pain; thoracic or midback pain; lumbar or low back pain.
10 Epidural Injections Block VS Indwelling 01996 Daily hospital management of epidural or subarachnoid continuous drug administration
11 Nerve Anesthetic Blocks (Nerve blocks) may be reported on the date of surgery if performed for postoperative pain management.Nerve block codes should not be reported separately on the same date of service as a surgical procedure if used as the primary anesthetic technique or as a supplement to the primary anesthetic technique.
12 Nerve Anesthetic Blocks Modifier 59 may be utilized to indicate that a nerve block injection was performed for postoperative pain management, rather than intraoperative anesthesia, and a procedure note should be included in the medical record.
14 Transforaminal Injections The approach for a transforaminal injection is by way of the intervertebral foramen. There are two foramen for each vertebra on opposite sides of the spine.The needle is inserted to gain access to the epidural space and nerve root.