Exploring Coding Rationale for Pain Management

Interventional radiology is an area ripe with opportunities for coding errors, with as much as 30 percent being coded inaccurately according to experts. Chronic pain is a significant health issue in the United States, with more than one in five adults having experienced chronic pain. This is even more prevalent within the Medicare population with 65 percent of adults over sixty-five impacted by chronic pain. Globally, it is the number one cause of disability and disease. In particular, pain management has several nuances worth noting in order to code successfully. Here are some, but not all the tips necessary to help tackle this area.

Actionable Tips and Rationale

1. Submit fluoro or CT guidance code only once per procedure regardless of how many levels are studied. Verify third-party payer policy on whether multiples of the guidance code may be used.
   
2. If performing bilateral procedures, be certain to verify local payer requirements when charging for both sides. Options may include -50, -RT and –LT, or units. Guidelines in the CPT manual now state that modifier -50 may not be reported with add-on codes. However, local payer policy may differ. Be certain to clarify reporting requirements for your specific region.
   
3. For each additional level studied (i.e., C-2 and C-3, L-3 and L-4, etc.) after the primary level report each additional level code choice.
   
4. Codes 62320–62327 are reported once per region, depending on where the needle goes into the body, not where the needle tip moves to or into what region the injected agent spreads. For instance, if the needle enters the patient at the L1–2 area, but the tip of the needle enters the thoracic region with spread of the medication in the thoracic region, code 62323 would be reported (assuming imaging guidance). Codes 62320–62323 would be reported instead of 62324–62327 if a catheter is used for introduction of medication, but removed that same day. Code 72275 was deleted in 2022, epidurography is included in these codes.
   
5. When CPT uses language such as “with and without,” “with or without,” “including” or “and/or,” it is incorrect to unbundle into a separate charge for the service following this language. Do not charge for fluoro guidance in addition to surgical code for this procedure.
   
6. When assigning codes for needle-guided procedures, remember to choose two charges: one 7XXXX code describing the modality used (i.e., fluoroscopy, CT, etc.) and one 10XXX–69XXX code describing the anatomic site treated.
   
7. For example, the upper or lower extremities, etc., consult CPT for complete explanations.
   
8. Codes 22510–22512 are only to be reported once per vertebral body treated whether unilateral or bilateral injections are done. Do not bill separately for contrast venography performed at the same setting as vertebroplasty. Do not code separately for bone biopsy when performed at the same time as vertebroplasty. Do not use these codes for kyphoplasty. Instead, see codes 22513–22515. There is no guidance code that should be charged in addition to these bundled codes.
   
9. Report this code (62263) only once from start to finish, when multiple days are needed for therapy. No fluoro guidance codes should be assigned during this service.
   
10. This code (62264) includes fluoro guidance, so no separate charges for this portion of the service should be submitted.

These are not all the necessary coding tips and rationale essential for correct pain management coding and compliance. As service volumes rebound, now more than ever it is imperative to make sure your CPT® coding is correct and compliant. Master more interventional radiology topics and break down the complexity with expert-infused insight. Our 2022 Pain Management Interventional Radiology Coding webcast is an essential training tool for both audio and visual learners.

Information source for chronic pain statistics: https://www.asbestos.com/cancer/chronic-pain-statistics/