Pain Management CPT Code Updates and Guidelines 2022

Chronic pain management is as much a challenge for physicians as it is for patients. Physicians utilize multiple modalities such as interventional procedures and noninvasive techniques to treat pain and help patients to best manage the problem. As they implement multimodal pain management programs, providers need to assign valid codes on claims to describe the patient’s condition for which the services were rendered. With constant changes in state and federal regulations, billing rules and codes, this is a challenging task. Our pain management medical billing company is focused on helping physicians to stay current with these trends and submit error-free claims. Let’s take a look at the pain management CPT code updates and guidelines for 2022 as well as other codes that are currently in use.

Pain Management CPT Code Changes 2022

In 2022, two CPT codes have been deleted and replaced with new codes that provide more granularity about procedures performed.

Deleted codes:

01935 (Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic)

01936 (Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic) are deleted in CPT®2022 and replaced with new codes that provide more granularity. New codes 01937-01942 identify the type of surgical procedure for which anaesthesia is being performed and whether the procedure is performed on the cervical or thoracic spine or the lumbar or sacral spine.

New codes:

There are nine new CPT codes for 2022 for anaesthesia and pain medicine. New codes 01937-01942 categorize the type of surgical procedure for which anaesthesia is being provided and whether the procedure is performed on the cervical or thoracic spine or the lumbar or sacral spine.

• 01937 Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic
• 01938 Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; lumbar or sacral
• 01939 Anesthesia for percutaneous image-guided destruction procedures by the neurolytic agent on the spine or spinal cord; cervical or thoracic
• 01940 Anesthesia for percutaneous image-guided destruction procedures by the neurolytic agent on the spine or spinal cord; lumbar or sacral
• 01941 Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; cervical or thoracic
• 01942 Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral
• 64628 Thermal destruction of the intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral
• 64629 Thermal destruction of the intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)
• 93319 3D echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) (eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (List separately in addition to code for echocardiographic imaging)

Other Frequently Used Pain Management CPT Codes  

• Acupuncture

Acupuncture involves inserting tiny needles through the skin in specific areas in the body to relieve pain and restore energy flow. This option is also used for migraine headaches, stress management and to promote overall wellness. Acupuncture can help soothe neck and lower back pain and discomfort due to osteoarthritis and knee pain, according to the National Center for Complementary and Integrative Health Trusted Source.

Effective January 21, 2020, Medicare began covering all types of acupuncture as a lower back pain treatment within specific guidelines in accordance with NCD 30.3.3. Medicare covers up to 12 sessions of acupuncture treatment within a 90-day window for those with chronic lower back pain.

Acupuncture CPT Codes

• 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
• 97811: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
• 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
• 97814: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles

Acupuncture is reported based on 15-minute increments of personal (face-to-face) contact with the patient, not the duration of acupuncture needle(s) placement.

• Report 97810 or 97811 if no electrical stimulation is used during a 15-minute increment, use.
• Report 97813 or 97814 if electrical stimulation of any needle is used during a 15-minute increment
• Report only one code for each 15-minute increment
• Use 97810 or 97813 for the initial 15-minute increment
• Report only one initial code per day

• Dry Needling

Dry needling, also called “trigger point acupuncture” is reported using the following CPT code

• CPT code 20560 (Needle insertion(s) without injection(s); 1 or 2 muscle(s)
• CPT code 20561 (Needle insertion(s) without injection(s); 3 or more muscles)
• When the origin or insertion of a tendon is injected, use 20551 should be used. Injection of the tendon sheath should be reported using 20550.
• CPT instructs that that CPT codes 20552 or 20553 (trigger point injections) are not reportable with CPT codes 20560 or 20561 when performed for the same muscles.

• Radiofrequency Ablation

Radiofrequency ablation (RFA) is a minimally invasive procedure that delivers an electric current to a small nerve tissue area to stop it from transmitting pain signals. It can provide lasting relief for conditions like chronic pain, especially in the lower back, neck and arthritic joints. Mild sedation may or may not be used. The CPT codes to report RFA are:

64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

64999 Unlisted procedure, nervous system

• Use 64625 to report radiofrequency ablation whether performed using traditional or cooled radiofrequency (<80 degrees Celsius)
• Use 64999 to report pulsed radiofrequency ablation should be reported using CPT code 64999.

CPT codes need to be submitted with ICD-10 codes that support medical necessity. Services provided must be reasonable and necessary in the specific case and also meet the criteria specified in the attached determination.

As needle placement aspects can have a significant effect on the codes, accurate documentation is essential to assign the right codes.  With a wide array of codes to describe various diagnostic and therapeutic procedures and references to injection location, coding pain management procedures can be a pain for physicians. Outsourcing pain management medical coding and billing to an expert is the best way to handle this challenge. Companies providing medical coding services for this speciality have AAPC certified coders. Experts will query the physician to clarify procedures performed, assign the right codes, and ensure correct claim filing for maximum reimbursement.