CPT coding for pain management is really a hectic task and outsourcing it to a reliable medical coding company helps you earn more while focusing on your core processes

1. Summary: CPT coding for pain management is really a hectic task and outsourcing
it to a reliable medical coding company helps you earn more while focusing on your
core processes.
CPT Coding for Pain Management
Pain management professionals are busy healthcare practitioners as their area of
practice is vast and the patients belong to diverse age groups. The types and levels
of pain is yet another factor, varying from neoplasm-related pain, spinal pain, acute,
chronic to post-surgical pain. This article discusses some important CPT codes that
will be useful for diverse pain management professionals including medical
practitioners, clinical psychologists, physiotherapists, nurse practitioners,
occupational therapists, and clinical nurse specialists.
CPT coding for pain management is difficult and requires considerable knowledge on
the part of the medical coder who carries out the task in-house. It is easier to
entrust the job to a medical coding company that can offer the service of trained,
professional medical coders and billers.
Commonly Used CPT Codes
Joints and Bursa – Injection or Aspiration
• Major joint/bursa: 20610 (Arthrocentesis, aspiration and/or injection; major
joint or burse(knee, hip, shoulder, trochanteric bursa, subacromial bursa, pes
anserine bursa) This does not include the injectable drug which should be
billed separately with the appropriate J code
• Fluoroscopic needle guidance (non-spinal): 77002
Tendons, Ligaments, and Muscle Injections
• Tendon origin/insertion: single 20551
• Trigger point injection (3 or more muscles): 20553
Nerve Blocks
• Greater occipital nerve block Injection- anesthetic agent: 64405
• Intercostal nerve (single) Injection, anesthetic agent: 64420
Epidural Steroid Injections (ESI)
• Interlaminar – cervical or thoracic: 62310
• Transforaminal – cervical or thoracic (first level): 64479

2. Facet Joint Procedures
• Intraarticular joint or medial branch block (MBB) – cervical or thoracic (1st
level or site): 64490
• Intraarticular joint or medial branch block (MBB) – lumbar or sacral (3rd level
or site): 64495
Radiofrequency Ablation (RFA) / “Destruction” of Facet Joint
• Radiofrequency ablation (RFA) – cervical or thoracic (1st joint): 64633
• Radiofrequency ablation (RFA) – lumbar or sacral (each additional joint):
64636
Sacroiliac Joint
• Sacroiliac joint (SIJ) with fluoroscopy: 27096
• Sacral lateral branch blocks: 64450
Vertebroplasty
• Vertebroplasty – Thoracic (1st level): 22520
• Vertebroplasty – Lumbar (each additional level): 22522
Kyphoplasty
• Kyphoplasty – Thoracic (1st level): 22523
• Kyphoplasty – Lumbar (each additional level): 22525
CPT Coding Changes 2013
Revised Codes
• 76942- Ultrasonic guidance for needle placement, (e.g. biopsy, aspiration,
injection, localization device), imaging supervision and interpretation
• 64612- Chemodenervation of muscle(s); muscle(s) innervated by facial
nerve, unilateral (e.g. for blepharospasm, hemifacial spasm
• 64561- Percutaneous implantation of neurostimulator electrode array: sacral
nerve (transforaminal placement), including image guidance, if performed
• 64614- Chemodenervation of muscle(s); extremity and/or trunk muscle(s)
(e.g. for dystonia, cerebral palsy, multiple sclerosis
New Codes
• 64615- Chemodenervation of muscle(s); muscle(s) innervated by facial,
trigeminal, cervical spinal and accessory nerves, bilateral (e.g. for chronic
migraine)
• +95940 - Continuous IONM in the OR one on one monitoring requiring
personal attendance, each 15 minutes

3. • 95907-95913- Nerve conduction tests studies new codes in 2013 are used to
reflect number of studies performed, rather than each nerve, as the unit of
service.
• +95941 - Continuous IONM, from outside the OR (remote or nearby) or for
monitoring of > 1 case while in the OR, per hour
Deleted Codes
• 95900, 95903 and 95904- nerve conduction tests codes
• +95920- Intraoperative neurophysiology
Highlights of CPT Coding Updates
• None of the anesthesia codes were
added, deleted, or revised for 2013.
• CPT 2013 defines time for all time-based
codes. These are codes the selection of
which depends on the amount of time
required to perform the service. “Time is
the face-to-face time with the patient”
unless other specific instructions are
contained in the code or code range
instructions. A unit of time coincides
with the passing of the midpoint. In case
a different service is performed side by
side with a time-based service, the time
required for the concurrent service
cannot be included in the time used to
report the time-based service.
• A complete rewrite of the Medicine-Psychiatric Services section is made in CPT
2013 including revised codes, 11 new codes, and 27 deletions.
• Parenthetical note for code 76942, imaging supervision, interpretation and
ultrasound guidance for needle placement has changed.
• The term “Qualified Healthcare Professional” (QHP), and its usability has been
introduced. Distinct from “clinical staff,” a “physician or other qualified
healthcare professional” refers to an individual who is qualified by education,
licensure/regulation, training and facility privileging (when applicable), who
performs a professional service within her/his scope of practice and
independently reports that service. “Clinical staff” cannot individually report a
professional service that he/she has assisted in.
Some Rules for Pain Management Coding
• To report postoperative pain management, CPT codes 62310-62319 shouldn’t
be used if a narcotic or other analgesic and anesthetic agent are injected
postoperatively through the same catheter.
• CPT codes 64615 and 64614 can be reported only once per session.
• Modifier 50 is to be reported for performing bilateral procedures.

4. • The billing could be separately done if the surgeon is assisted by the
anesthesiologist by performing an epidural or peripheral nerve block injection
for postoperative pain management.
• Modifier 52 is to be reported for an incomplete procedure.
Merits of Outsourcing Pain Management Coding
Instead of carrying out the heavy task of pain management coding in-house, you
could benefit a lot by outsourcing the task to a reliable medical coding and billing
company. Benefits include:
• Regular follow-up with insurance companies
• Enhanced cash flow and better collections
• HIPAA compliant medical coding services
• Efficient management of the claim denial process
• Improved patient satisfaction
• Minimal chance of under coding and over coding
• Focus more on your medical practice
About Outsource Strategies International
Outsource Strategies International (OSI) is a HIPAA Compliant medical coding
company that provides medical coding outsourcing services to physicians, billing
companies, and individual doctors. The company utilizes advanced software such as
EncoderPro,FLashcode and CodeLink to facilitate speedy medical insurance billing
and coding. For more information visit http://www.outsourcestrategies.com/