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Questions for coders/billers RE pain management - sapient

Posted: Oct 28, 2010

Are there any billers/coders out there who specialize in pain magement, ie, facet injections/aspiration and lavage, etc, for outpatient pain management physicians?

I have questions about documentation needed for injections and such with the 'add on codes', for example with the injections, there are codes for the first level then additional codes for second and subsequent levels. Is it necessary for every single charge to have a report on it? It's causing severe headaches for the MT department where I work because we have a new anesthesiologist and the staff is new to pain magnement and nobody seems to know what to do with her stuff.

If anyone can give me any references or someplace to look to figure this stuff out. I don't want to be questioning my coworkers and supervisors all the time but it just seems like we are making things much harder than they need to be.

Injections - jm

[ In Reply To ..]
Probably not much help but for coding purposes, the procedure of injections at different levels is one report, one visit. If the doctor does an injection at L3-L4 and L4-L5 that is two levels, two codes, but it is one report. The add-on code is just to show that he did another level, but he did it all in one visit on one date. Is that what you mean? Sorry, I donâ��t know anything about the charges or billing part.

That's exactly what I mean - sapient

[ In Reply To ..]
They are making me do reports for every charge... seems a little crazy especially considering I am just copy and pasting the same dictation.

Do you know anywhere that I can show that as a rule? Maybe somewhere online that shows the standard reporting for those things, or a manual I can get?

injections - jm

[ In Reply To ..]
I guess I donâ��t know what you mean by every single charge needing a report. Do you do the transcription and print the reports? Here is a scenario for you. If a joint injection is done at lumbar paravertebral facet at three or more levels, the CPT codes would be 64493, +64494, +64495. The last two are â��add-onâ�� codes. Add-on codes cannot stand alone. They can only go with the initial code which is 64493. (image guidance is included in these codes). This is done in one session. Are you saying they want you to separate out each code and place on different reports? Or are they on different dates?

sm - sapient

[ In Reply To ..]
I type the reports. What we do is she dictates on 64493 then I copy and paste that report onto the charges for the additional codes (64494-64495), so there are 3 reports in the chart.

I personally think since they are add ons that they don't need their own reports, but we can't link them to the original report, so they come through as not having a report attached to them. My question is, for billing, do they need a report attached to them if the original code/charge/appointment has a report and everything was done the same day at the same time?

Oh - jm

[ In Reply To ..]
Over my head! Sounds like some sort of software system linking error. Cannot help you there, sorry. I guess they found a work around, unfortunately it is YOU doing that extra work. It seems like it could be solved better by the IT Department. Sounds like those codes need to be added to some system. Try to go to the source and find out why and when they are going to fix it.

ONE report - Redpen

[ In Reply To ..]
Your understanding is correct -- this is one procedure and ONE bill. Everything that doctor does for that patient in one session needs to be on ONE report.

Let's say one surgeon is fixing a fractured tibia and fibula at the same time. You wouldn't write one report for the tibia and another for the fibula, would you? Everything done in one operative session normally goes into one report. That is what you have here.

Breaking it up into separate reports is not wrong, exactly. Not very useful, but it isn't criminal. However, if the purpose of this multiple report business is to enable the provider or facility to bill this on several separate bills as multiple first levels, rather than a first level and multiple add-on second and subequent levels, the billing would be inappropriate (possibly fraudulent).

No, not fraudulent, just confusing :-) - sapient

[ In Reply To ..]
Thanks. They are not trying to bill them seperately, I think it's just the way our system is set up and the fact that most of hte staff is new to this type of thing, we are still working out the kinks, but I'm not a coder so I don't want to try to tell them something is unnecessary when I don't really know.

A thought . . . - Redpen

[ In Reply To ..]
You're basically trying to get a report on each code, then, because your system handles each code separately? I've seen systems like that. Usually, you put the entire report on each and every code . . . you do not break the report up into chunks.

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