Billing and Coding Tips for Spine and Pain Management

by | Published on Feb 16, 2017 | Resources, Medical Coding News (A) | 0 comments

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Pain management medical coding is critical for diverse clinical specialties including neurology, radiology, orthopedics, spine surgery and others. For timely reimbursement of complex spine and pain management procedures, ambulatory surgery centers (ASCs) should ensure proper claims submission with accurate medical codes. Spine-related pain can be associated with nerve root compression, facet arthropathy, and intervertebral discs among other conditions. Diagnostic spinal procedures offered may include lumbar puncture, myelography, discography, biopsy and aspiration along with plain film radiography, nuclear medicine, CT, and MRI studies. Medical billing outsourcing is an ideal option for ASCs to smoothen their billing process. An established medical billing and coding company will submit medical bills and claims within the specified time limit and maximize cash flow.

Strategies Medical Coders Can Implement to Improve Documentation

As coding errors can lead to charge capture errors and missed opportunities for payment, it is critical for ASC medical coders to follow certain strategies to improve spine and pain management documentation and charge capture.

  • Identify the payer and their medical coverage policies – It is crucial for pre-authorization staff to know who is responsible for paying medical claims, so that they can submit authorization requests to the proper entities in a timely manner. In some cases, commercial payers may require more detailed information.
  • Better management of denials work – A clear understanding of why claims are denied is critical to identify and address issues in ASC revenue cycles. Often, reasons for denials could be simple billing mistakes such as demographic errors, incomplete claim submission and invalid modifiers or diagnosis codes. New documentation strategies can be implemented only by analyzing claims denials.
  • Get familiar with CPT codes and anatomy – Medical coders should be knowledgeable about the full anatomy of the spine, which helps them to interpret the correct operative note for surgical approach, level assignment and diagnosis assignment. Also, make sure to use the most accurate CPT codes that help ASCs and physicians to receive complete and proper reimbursement for the services rendered.
  • Get complete and detailed physician documentation – To make sure that medical coders assign the right medical codes, physicians must provide complete and detailed operative notes. For instance, in spine surgeries, decompression documentation should specify each nerve targeted at each level for maximum reimbursement. Before coding a new surgical approach, coders must understand whether new techniques are considered open or endoscopic procedures.

It is also recommended that the medical billing staff learn coding practices for all new medical devices. Thorough research is necessary to learn appropriate coding practices for each new medical device to ensure claim approval.

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