Pain Management Billing and Coding: Common Mistakes and Challenges
Date Posted: Monday,
September 26, 2022
There is currently plenty of room to grow in pain management facilities, particularly since the American Academy of Pain Medicine estimates that over 100 million Americans suffer from chronic pain. That's much higher than the total number of people affected by diabetes, heart disease, and cancer. There is a lot of potential for expansion, but certain pain management codes and billing requirements make it difficult to succeed. Effective billing and coding are only half the battle when trying to increase the revenue of your practice. Avoid the most common mistakes in billing and coding to ensure your pain management practice is set to develop and prosper in the coming year.
Avoid Billing Procedures Based Solely on Summaries
One of the most common mistakes made in the billing and coding of pain management is to bill for a procedure only based on an overview. According to Medicare, it is only allowable to bill for procedures that have been recorded within the body of a report. Coders must be aware of the full report for coding and billing purposes.
Ensure Errors in Medical Billing Records are Properly Corrected
As making sure documentation requirements are met is essential to ensure payors are actually paying for services, addressing mistakes in medical records is vital. Physicians should not scratch words out or apply correction fluid in the patient's records. If there's an error within the patient's medical records, the error should have only a single line traced through it in ink. The term "error" should be written over it, and the corrections should be made. It is also crucial for doctors to sign off on the corrections made to the patient's records.
Look Out for "Canned" Reports
Physicians may be tempted for certain procedures to use "canned" reports or report templates rather than producing a report specifically customized to the particular patient and procedure for pain management. However, these templates might not include all the necessary information needed to document the procedure properly. In certain instances, the report might not contain information about the exact procedure followed or provide the specific side of the body on which the procedure was performed.
Examine and Verify Codes Listed in Reports
Another expensive error in billing and coding is to simply record codes that doctors provide in their reports. Correct coding requires examining these reports to ensure that the codes accurately and effectively represent the services rendered by the doctor. It's also important to confirm that proper documentation has been given for the procedures that are being recorded.
Fluoroscopy in Pain Management Medical Billing Often Results in Errors
One of the most common mistakes in medical billing for pain management is to charge fluoroscopy as a separate procedure. The procedure is included in a variety of codes for pain management, including discography, intraarticular joint procedures, facet block medial branch surgeries, transforaminal epidural injections of steroid, and radiofrequency ablations. In many cases, billing fluoroscopy independently causes duplicate claims that are made for one procedure, which results in expensive denials that can affect the bottom line of your business.
Don't Forget About Modifier 50
When you code bilateral procedures, be sure to add modifier 50. This modifier offers additional details about the procedure to be coded. Modifier 50 is specifically an action or procedure that's executed across both sides of the body in a single session. However, it is common to forget modifier 50, or simply code each body part separately.
Continuing Changes Result in More Challenges for Pain Management Medical Billing
The reimbursement for pain management evolves regularly, and the procedures for documentation you've employed in the past could soon be leading to denials. Payors now require more and more precise documents. The codes for pain management keep changing, too. Along with coding and policy changes, your practice's coding personnel must stay up to date with these changes and adjust your procedures according to the requirements of each payor. However, keep in mind that any modifications could also lead to difficulties in keeping the revenue cycle running for the practice.
For many pain management practices, outsourcing to a professional medical billing and coding service aids in solving this issue. At M-Scribe, they have extensive expertise in coding and billing for pain, as well as relationships with pain management clinics across the United States. In addition to providing you billing and coding services, they provide contracting services, as well. Contact M-Scribe to find out how they can assist you to boost the revenue of your pain management practice.
Eve Liam is a freelance writer and author of a dozen books. She has several years experience writing about the healthcare field with articles on compliance education, reimbursement analysis, client relationship management, and worktime optimization. She specializes in business development and revenue optimization. Her extensive knowledge of medical billing helps guide new billers and coders on how to maximize revenue by minimizing denials.