Assigning ICD-10 Codes and Modifiers for Pain Management

Hey all, this is Loralee Kapp, a Solutions Manager with Managed Outsourced Solutions and today, I want to go over the best practices to assign ICD-10 codes & modifiers for pain management.

As the complexities in billing and coding pain management are increasing each year, it is important for practices to focus more on documentation as well as carefully handle pain management billing and coding. A reliable medical billing company can support medical practices to efficiently manage their revenue cycle, while providers and staff can focus more on patient care. For any medical specialty, solid coding and billing is crucial to receive accurate and timely reimbursement, prevent claim denials and audits, and maintain financial well-being.

It is critical for pain management providers to ensure that injections like facet joint injections and nerve blocks are accurately documented. Multiple levels of treatment procedures are there while administering these injections. Each patient visit has to be recorded in the original operative note or an addendum. Any missing information can delay the processing of the claims, resulting in denied or delayed reimbursement.

01:14 Pain Management Coding – Best Practices

In pain management coding, it is necessary to provide a detailed diagnosis description –

• include the cause, the site and laterality of the pain
• include a qualifier as well as specific details about the pain

Appropriate documentation of injections administered

Accurately document –

• details of the epidural injections
• various routes of administration for injections and the final position of the needle used
• fluoroscopically-guided interventions
• the diagnosis notes that support the procedure
• details of the specific medicine administered as injection
• trigger point injection to treat various muscle groups

Lastly, know the modifiers used in pain management

Some modifiers commonly used in pain management are –

• -LT: anatomically left-RT, anatomically right
• -50: bilateral (use them while coding bilateral procedures)
• -59: notes that a service or procedure is independent and separate from other services that were performed on that same day
• -52: incomplete procedure, stopping part of the procedure due to reasons other than patient well-being
• -53: incomplete procedure, the physician chooses to end a procedure for the patient’s well-being

Remember that the codes can change every year and it is essential to stay updated on these changes. Also, any missed or inaccurate recording of the modifiers can result in claim denials. Stay up to date with billing guidelines and payer policies to ensure maximum reimbursement. Outsourcing medical billing tasks can help medical practitioners to focus on the patients, instead of back-office tasks.