Key Pain Management Coding Questions Answered

Posted on 15 Apr, 2019 |comments_icon 0|By Elizabeth Debeasi
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Need expert help for pain-free pain management coding?

A diagnosis for the cause of a patient’s pain isn’t always possible, and pain treatment varies widely from physician to physician. These two traits make pain management unique among medical specialties, which can make pain management coding uniquely challenging.

But one thing remains true for all specialties — the right code can mean a substantial difference in reimbursement. That’s why we’ve asked Chris Boucher, our resident pain management coding expert, to help you prevent reporting errors from siphoning off your hard-earned pay.

Read on for pain-free guidance to navigate a few common-but-costly pain management coding scenarios.

Question 1: Update 2-view Radiologic Spine Examination Coding

After a level-three evaluation and management (E/M) service for a new patient, the provider performs a two-view radiologic examination of a patient’s entire spine (anteroposterior and lateral). I reported 72010 for the radiologic exam and received a denial. What did I do wrong?

Answer: Your coding would have been correct a few years ago, but the code you reported for the exam — 72010 (Radiologic examination, spine, entire, survey study, anteroposterior and lateral) — is no longer in service.

The correct coding for your scenario would be:

  • 72082 (Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views) for the exam
  • 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity …) for the E/M.

Your mistake sounds like it might be the product of using outdated CPT® resources. According to the Spine and Pelvis Subset of the Radiology Section in CPT® 2019, “72010 has been deleted. To report, use 72082.”

This illustrates the kind of risk you run by using outdated CPT® resources. If you choose an outdated code, and have no access to new resources, it’s going to be a tough slog to run down the correct code. Though it’s a pricey annual expense, you really should have new versions of CPT®, ICD-10, and HCPCS each year.

Question 2: Check Trauma Status on Cuff Tear

My provider performed a level-three evaluation and management (E/M) service for an established patient with a torn rotator cuff. What’s the correct ICD-10 code?

Answer: You’ll need to know whether the tear was nontraumatic or traumatic before you can add the correct ICD-10 code to your 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity …) claim.

Nontraumatic: If the notes do not mention that the cuff tear was traumatic, then you’ll choose from one of the following code sets, depending on encounter specifics:

  • M75.10- — Unspecified rotator cuff tear or rupture, not specified as traumatic
  • M75.11- — Incomplete rotator cuff tear or rupture not specified as traumatic
  • M75.12- — Complete rotator cuff tear or rupture not specified as traumatic.

6th character needed: Whichever diagnosis code you choose from the above list, you’ll need to include a sixth character to indicate laterality.

Traumatic: If notes specify that the tear was traumatic, you’ll choose one of the codes from the S46.01 — (Strain of muscle(s) and tendon(s) of the rotator cuff of shoulder) family, depending on encounter specifics.

7th character needed: For traumatic rotator cuff tears, you’ll also need a seventh character to indicate the type of visit, along with the sixth character for laterality.

Question 3: Choosing the Right Code for Destruction of the Trigeminal Nerve

An established patient with trigeminal neuralgia reported to our physician complaining of facial pain. After a level-three E/M service, the physician performed destruction of the trigeminal nerve. How should I report this encounter?

Answer: Your final code choice will depend on which branch of the trigeminal nerve the physician destroyed. Go back to check the encounter notes and then choose one of the following codes depending on encounter specifics:

  • 64600 — Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch
  • 64605 — … second and third division branches at foramen ovale
  • 64610 — … second and third division branches at foramen ovale under radiologic monitoring.

Regardless of which code you choose, you’ll append G50.0 (Trigeminal neuralgia) to the procedure code to represent the patient’s condition.

Also use G50.0 with 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity … ) for the E/M service. Attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99213 to show that the E/M and nerve destruction were significant, separately identifiable services.

Contributing Editor: Chris Boucher

Need More Pain Management Coding Tips?

Put an end to avoidable denials, needless audit risks, and debilitating payback demands with your monthly subscription to Pain Management Coding Alert. Every issue of this indispensable resource delivers high-impact tips and advice as our experts tackle the revenue-risking challenges that threaten your claims and compliance success.

The Coders’ Specialty Guide 2019: Pain Management includes all CPT® and HCPCS codes relevant to pain management, simple descriptions that explain each code, expert advice for assigning codes, Medicare reimbursement details, diagnosis codes crosswalk, applicable modifiers, CCI edits, global days, code index, hundreds of anatomical illustrations, and more.

Author

Elizabeth Debeasi
Marketing Writer/ Editor

Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of Telehealth services.

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