2014 CPT Coding Changes for Pain Management

by | Published on Dec 13, 2013 | Specialty Coding

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Pain is a very complex phenomenon and pain management physicians have to treat patients of diverse age groups with levels of pain varying from neoplasm-related pain to post-surgical pain. Given these conditions, it is real a challenge for pain management practices to report the services and treatments they offer correctly for appropriate and timely reimbursement. New CPT codes for pain management that will become effective from January 1, 2014 are expected to help these specialists report their services and treatments more accurately. It is crucial for pain management physicians to understand these changes in order to ensure accurate pain management coding and medical claim billing.

Chemoden treatment involves the injecting of botulinum toxin, atropine or other pharmacologic compounds into a neural structure or muscle to paralyze it and hamper its ability to cause the sensation of pain is crucial in pain management.
In addition to painful muscle contractions in the trunk such as those caused by tetanus, latrodectism, and abdominal rigidity, physicians can also use this treatment to treat pain response for tennis elbow.

  • If the treatment is provided to the patient’s neck muscles, a new code 64616 (chemodenervation of muscle[s]; neck muscle[s], excluding muscles of the larynx, unilateral [e.g., for cervical dystonia, spasmodic torticollis]) should be reported instead of 64613 (chemodenervation of muscle[s]; neck muscle [s] [eg, for spasmodic torticollis, spasmodic dysphonia])
  • If the treatment is offered for painful muscle contractions in the trunk caused by tetanus, Latrodectism (black widow spider bite) or abdominal rigidity (acute, involuntary contractions of the rectus abdominis, and internal and external oblique muscles), it should be reported with either of two CPT codes given below instead of 64614 (chemodenervation of muscle[s]; extremity and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis])
    • 64646: chemodenervation of trunk muscle(s); 1-5 muscle(s)
    • 64647: chemodenervation of trunk muscles; 6 or more muscles

The chemodenervation treatments of the extremities should be reported with one of four new codes given below.

  • 64642: chemodenervation of one extremity; 1-4 muscle(s)
  • +64643: each additional extremity, 1-4 muscle(s)
  • 64644: chemodenervation of one extremity; 5 or more muscle(s)
  • +64645: each additional extremity, 5 or more muscles

Physicians (those who are not neurologic specialists) usually initiate interprofessional consultation via telephone or the internet when a patient is suffering from acute/chronic pain and need immediate relief as there is no time to wait for face-to-face consultation. The latest CPT codes for pain management constitute the following new evaluation and management codes to report interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional, where the length of time determines the correct code.

  • 99446: 5-10 minutes of medical consultative discussion and review
  • 99447: 11-20 minutes of medical consultative discussion and review
  • 99448: 21-30 minutes of medical consultative discussion and review
  • 99449: 31 minutes or more of medical consultative discussion and review

The new Category II codes related to pain management, especially for patients having neuropathy – a common manifestation of diabetes mellitus are:

  • 1500F: symptoms and signs of distal symmetric polyneuropathy reviewed and documented
  • 1520F: patient queried about pain and pain interference with function using a valid and reliable instrument
  • 3751F: electrodiagnostic studies for distal symmetric polyneuropathy conducted (or requested), documented, and reviewed within 6 months of initial evaluation for condition
  • 3752F: electrodiagnostic studies for distal symmetric polyneuropathy not conducted (or requested), documented, and reviewed within 6 months of initial evaluation for condition

Accurate pain management medical coding using the new codes can be ensured with professional medical coding services. Expert AAPC-certified coders who are up-to-date on the latest developments on the coding scene are part of an established medical billing and coding company’s team. Seeking professional support can minimize coding errors and improve the productivity and revenue of physician practices.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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