Pain Management Coding

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 62310 – 62319 √ Imaging X Bilateral X Multi - level

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.

13. Nerve Anesthetic Blocks • AKA: Nerve Blocks CPT CODES 64400-64530 √ 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 64479 – 64484 X Imaging √ Bilateral √ Multi – level

16. Facet Joint Injection • AKA: Paravertebral Spinal Nerve; Medial Branch Nerve; Facet Joint Nerve Injections CPT 64490 – 64495 X Imaging √ Bilateral √ Multi – level

17. Destruction by Neurolytic Agent • Radiofrequency ablation procedures are reported with the appropriate destruction codes. CPT 64600 - 64636 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 64611-64614 √ 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