Pain Management Procedures Injections Destruction by Neurolytic Agent Intrathecal Catheters with Subcutaneous Pump Delivery Systems Spinal Neurostimulators Epidural Neurolysis IDET – Intradiscal Electrothermal Therapy
Steps to Pain Coding Know the approach Epidural Transforaminal Facet Know the type of injection Anesthetic Steroid Neurolytic agent
Steps to Pain Coding Know the regions treated Regions: cervical thoracic lumbar sacral Know the levels treated One or Multiple
Steps to Pain Coding Know the injection restrictions Unilateral or Bilateral Know when fluoroscopy/ultrasound guidance reporting is allowable Know the global days
Anatomy of Spinal Cord Covered by 3 layers of protective membranes: Outside to Inside: Dura Mater Arachnoid Mater Pia Mater
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
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.
Epidural Injections AKA: Interlaminar, Interlaminar epidural, ESI, Translaminar Epidural, Standard Epidural CPT CODES – √ Imaging X Bilateral X Multi - level
Epidural Injections Block VS Indwelling Daily hospital management of epidural or subarachnoid continuous drug administration
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.
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.
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.
Transforaminal Injections AKA: Steroid Anesthetic Agent; Transforaminal Epidural CPT CODES – X Imaging √ Bilateral √ Multi – level