Pain Management Billing – The Growing Concern of Malpractice Claims

by | Last updated Jul 4, 2023 | Published on Dec 31, 2014 | Specialty Billing

Pain Management Malpractice
Share this:

Chronic pain is a complex phenomenon and is often defined as pain that doesn’t go away or comes back frequently. As per recent statistics, more than 100 million adult Americans experience conditions associated with chronic pain resulting in an annual healthcare cost of around $600 billion in the US.

Pain management is a medical specialty area that is in constant flux with changes in technology, medical coding changes and changes in regulations that have considerable financial impact on medical practices. Practices have to comply with the regulations of the federal government and other regulatory agencies as well as those specific to insurers. It is vital that practices document medical necessity accurately. There should be a clear and logical correlation between various components of the patient’s medical record, treatment and outcome report and medical billing statement.

The treatments provided focus on providing the patient with complete relief from physical pain. There are different causes associated with this condition which may include injury, disease, neoplasm or post-surgical related causes. In most cases, providers have to treat patients of different age groups with varying levels of pain.

Pain management specialists may come from all fields of medicine and can be anesthesiologists, psychiatrists or neurologists. It is a challenging task for these physicians to accurately report the services and treatments offered. These physicians and their office staff should have essential coding know-how and a thorough understanding of the latest medical coding changes to submit accurate medical claims and ensure correct and timely reimbursement. Appropriate documentation supporting the medical necessity of the service provided is essential for insurers to accept the chronic pain management claims.

Increase in Chronic Pain Malpractice Claims – Finds a New Study

A new study presented at the American Society of Anesthesiologists 2014 Annual Meeting reports an increase in the total number of malpractice claims associated with chronic pain management which in turn is causing permanent disability, injury or even death. It is estimated that the malpractice claims related to this specialty have significantly increased, both in number and severity over the past years.

The number of specialists using more potent analgesics and interventions has also witnessed a huge increase. Anesthesiologists who perform cervical neuraxial injections and prescribe opioid medications need to be fully aware about the increase in severe adverse outcomes.

Earlier, many malpractice claims involved epidural steroid injections (CPT codes 62311, 64483 and 64484), wherein the injuries reported were minor and temporary. Recently however, analyses have identified an increase in major unfavorable outcomes such as death associated with medication overdoses and significant neurologic injury connected with pain treatment.

As part of the study, researchers evaluated the type of care, complications and overall trends in pain management malpractice claims between the years 1980 – 2012. A thorough analysis of about 10,367 anesthesia malpractice claims (from the Anesthesia Closed Claims Project Database) was done and the number of procedures performed by the anesthesiologists was closely evaluated. More than 1037 cases related to acute pain and 8545 related to surgical, obstetric related problems were found. The litigation for these procedures increased from 3% in 1980 to 18% in 2012. The other key findings of the study include –

  • Pain claims increased by 6.3% for every 10 years but the number of anesthesiologists increased by only 2.0% per 10 years.
  • A considerable change was also identified in the type of malpractice claims. Medication management (as a proportion of claims) increased from 2% to 17%, implantation, removal, and maintenance of devices increased from 3% to 16%, cervical neuraxial injections increased from 16% to 27% while lumbar injections fell from 37% to 17%.
  • Medical complications associated with these procedures reported a considerable increase over the 30-year period. In the 1980s, death was cited as a prominent reason for about 6% of chronic pain malpractice claims and serious nerve injury was the main reason for another 6%. After the year 2000, there was a significant increase in these rates to 19% and 28% respectively.

As per the data collected from the National Anesthesia Clinical Outcomes Registry (NACOR) about 303,267 procedures performed, lumbar injections accounted to 61%, cervical injections were 23% and device implantations accounted for 16% of the total pain management procedures. The malpractice claims accounted for a total of 44% out of which 29% were related to lumbar injections and 27% involved devices.

However, the researchers were not fully able to identify the prominent factors associated with the change in severity of outcomes appearing in acute pain misconduct claims. It is estimated that this shift in outcomes may be related to overall increase in this specialty care offered by anesthesiologists or due to changes in the type of treatment being offered.

How Physicians Can Prevent Medication Errors

Often, when it comes to treating chronic pain, medications play a prominent role. There are numerous medications that help to effectively manage pain and its associated conditions. Moreover, each patient’s condition will be different and they may respond to medications in a different manner. The type of medications required by each patient may depend on different factors such as treatment goals, intensity of the pain and overall health conditions. Depending on the individual condition, some patients may take prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) daily, while others may require something of high dosage, such as an opioid injections, trigger point injections and facet blocks or injections.

Pain medication/treatment is typically administered by physicians. However, there are certain times when a lot can go wrong with the physician. Prescription drug errors mainly fall under three categories – dispensing incorrect medication, giving wrong drug dosage and failing to check for known drug allergies or harmful drug interactions with other medications the patient is taking.

Errors can also arise from a number of other factors such as nursing error (involving the type of drug or the amount administered), pharmacy liability, anesthesia errors (administering too much anesthesia leading to over dosage), giving the incorrect prescription due to misunderstanding or illegible handwriting and prescribing dangerous or defective drugs. Mistakes arising from wrong or unnecessary prescription can often lead to serious injury, disability or even death of the patient. Therefore, doctors have to be careful when prescribing medications as part of their treatment.

Simple steps such as double checking medications and writing prescriptions clearly can be very well adopted by hospitals and medical providers to prevent these errors.

  • Natalie Tornese
    Natalie Tornese
    CPC: Director of Revenue Cycle Management

    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

  • Meghann Drella
    Meghann Drella
    CPC: Senior Solutions Manager: Practice and RCM

    Meghann joined MOS’ Revenue Cycle Management Division in February of 2013. She is CPC certified with the American Academy of Professional Coders (AAPC).

  • Amber Darst
    Amber Darst
    Solutions Manager: Practice and RCM

    Hired for her dental expertise, Amber brings a wealth of knowledge and understanding of the dental revenue cycle management (RCM) services to MOS.

  • Loralee Kapp
    Loralee Kapp
    Solutions Manager: Practice and RCM

    Loralee joined MOS’ Revenue Cycle Management Division in October 2021. She has over five years of experience in medical coding and Health Information Management practices.