Pain Management Coding
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Transcript Pain Management Coding
Pain Management Coding
Princess Padilla CCS CPC CANPC COSC
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 62310 – 62319
√ Imaging
X Bilateral
X Multi - level
Epidural Injections
Block VS Indwelling
01996 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.
Nerve Anesthetic Blocks
AKA: Nerve Blocks
CPT CODES 64400-64530
√ Imaging
√ Bilateral
√ Multi - level
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 64479 – 64484
X Imaging
√ Bilateral
√ Multi – level
Facet Joint Injection
AKA: Paravertebral Spinal Nerve; Medial
Branch Nerve; Facet Joint Nerve Injections
CPT 64490 – 64495
X Imaging
√ Bilateral
√ Multi – level
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
Destruction by Neurolytic Agent
X Imaging
√ Bilateral
√ Multi – level
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.
Chemodenervation Injections
AKA BOTOX injection
CPT CODES 64611-64614
√ X Imaging
√ X Bilateral
√ X Multi – level
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
Sources
ASA Relative Value Guide
AMA CPT
2012 Coding Changes for Pain Management
– Marvel Hammer RN CPC