Pain Management Coding: guidelines for correct claim submission

Posted by Practice Management Institute on Sep 19, 2022 9:45:00 AM
Practice Management Institute

Pain management treatments are primarily performed by an interventional pain management specialist, physiatrist, anesthesiologist, orthopedic surgeon, or neurosurgeon, and can include physical or occupational therapy, over-the-counter or prescription medication, neurostimulators, and injections.

"Very often a patient will try several forms of treatment to help with the pain, understanding that the purpose is not necessary to correct the problem but to manage the pain associated with it," says coding expert Lynn Anderanin. "Coders have to understand the different forms of treatment that can be performed in order to select proper ICD-10-CM diagnoses coding for pain management and the condition causing the pain."

Lynn is a senior coding educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. She has over 39 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations.  

"Understanding the patient journey is important for pain management from their first visit with their provider through the possible treatment options that they may receive to ultimately helping them become pain-free, or seeking more invasive treatment for the condition," Lynn said.

Insurance company policies spell out the pain management requirements to meet medical necessity. The treatments may involve medial branch blocks, radiofrequency procedures, epidural injections, neurostimulator trials, and insertion or trigger point injections. Coders with solid knowledge of insurance carrier policies related to pain management, and guidelines for medical necessity can more accurately code claims. 

Insurance often requires conservative treatment options to be performed over a period of time before more invasive procedures, including surgery, are scheduled. "The key is to find the best form of treatment for patients with pain due to injury or condition," she said.

Check out Lynn's online course:

Coding and Billing for Pain Management

Lynn's works primarily in the specialties of Orthopaedics, Rheumatology, and Hematology/Oncology. She is the founder of the first local chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other committees for the AAPC. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars.

Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area. 

Learn More

Topics: medical billing, Pain Management, medical coding, patient billing, medical office training

Subscribe Here!

Recent Posts

Posts by Tag

See all