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Pain Management Coding Princess Padilla CCS CPC CANPC COSC.

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Presentation on theme: "Pain Management Coding Princess Padilla CCS CPC CANPC COSC."— Presentation transcript:

1 Pain Management Coding Princess Padilla CCS CPC CANPC COSC

2 Pain Management Procedures Injections Destruction by Neurolytic Agent Intrathecal Catheters with Subcutaneous Pump Delivery Systems Spinal Neurostimulators Epidural Neurolysis IDET – Intradiscal Electrothermal Therapy

3 Steps to Pain Coding Know the approach Epidural Transforaminal Facet Know the type of injection Anesthetic Steroid Neurolytic agent

4 Steps to Pain Coding Know the regions treated Regions: cervical thoracic lumbar sacral Know the levels treated One or Multiple

5 Steps to Pain Coding Know the injection restrictions Unilateral or Bilateral Know when fluoroscopy/ultrasound guidance reporting is allowable Know the global days

6 Anatomy of Spinal Cord Covered by 3 layers of protective membranes: Outside to Inside: Dura Mater Arachnoid Mater Pia Mater

7 Anatomy of Spinal Cord Epidural – located over or upon dura mater Subdural – Beneath the dura mater Subarachnoid – Beneath the arachnoid mater Intrathecal – 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.

9 Epidural Injections AKA: Interlaminar, Interlaminar epidural, ESI, Translaminar Epidural, Standard Epidural CPT CODES – √ Imaging X Bilateral X Multi - level

10 Epidural Injections Block VS Indwelling 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.

13 Nerve Anesthetic Blocks AKA: Nerve Blocks CPT CODES √ Imaging √ Bilateral √ Multi - level

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.

15 Transforaminal Injections AKA: Steroid Anesthetic Agent; Transforaminal Epidural CPT CODES – X Imaging √ Bilateral √ Multi – level

16 Facet Joint Injection AKA: Paravertebral Spinal Nerve; Medial Branch Nerve; Facet Joint Nerve Injections CPT – X Imaging √ Bilateral √ Multi – level

17 Destruction by Neurolytic Agent Radiofrequency ablation procedures are reported with the appropriate destruction codes. CPT Includes chemical e.g. Phenol, Alcohol thermal electrical radiofrequency

18 Destruction by Neurolytic Agent X Imaging √ Bilateral √ Multi – level

19 Chemodenervation Injections Chemodenervation of muscles in the face, neck, extremity(s) and/or trunk. These services may involve injections of single muscle groups or multiple muscle groups.

20 Chemodenervation Injections AKA BOTOX injection CPT CODES √ X Imaging √ X Bilateral √ X Multi – level

21 Injection Documentation Each Level in title and verbiage of report Image guidance used and image kept Needle placement based on image where it entered Where the medications are going

22 Sources ASA Relative Value Guide AMA CPT 2012 Coding Changes for Pain Management – Marvel Hammer RN CPC


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