Don’t let the pain management billing process be a pain for your employees. Healthcare providers know that pain treatments vary with the type of disease. From acute pain and chronic pain to nociceptive pain, the challenge is that there are just as many codes as there are treatments. Billing these procedures requires an effective understanding of CPT codes.
Unfortunately, healthcare professionals make frequent coding mistakes, including using the wrong codes for different pain management procedures. But you can avoid this and all the tedious rework to undo claim denials by reading this comprehensive guide on pain management CPT codes.
Essential CPT Codes for Pain Management
You can only use pain management CPT codes effectively if you understand them. The Current Procedural Terminology (CPT) codes, developed by the American Medical Association (AMA), standardize the coding process. These codes optimize the billing process by increasing its accuracy and efficiency. However, CPT codes are not easy to handle.
The main reason is that the CPT code set is regularly updated, leading to frequent mistakes and claim denials. It means that pain management codes and guidelines are also revised frequently. Let’s discuss the most essential CPT codes based on the type of pain.
CPT Codes for Chronic Pain
Stress, anxiety, and depression often result in chronic pain. This disruptive pain lasts for months and can appear anywhere in your body. The National Institute of Health reports that chronic pain is more prevalent in American adults. Around 21% of US citizens suffer from this pain.
A high number of pain management clinics treat chronic pain through injections. Unfortunately, most chronic care providers don’t receive timely payments for their services due to incorrect coding. Some of the essential CPT codes for chronic pain management include:
CPT Code 63650
This medical procedure code falls under the range of Neurostimulator (Spinal) Procedures. It indicates that the healthcare provider has placed electrodes in the epidural space to reduce or remove spasms, relieving chronic pain.
CPT Code 63685
Severe back pain can hinder a person’s movement. Healthcare providers usually use spinal cord simulators to address chronic back pain.
CPT code 63685 is another one of the Neurostimulator (Spinal) Procedures. This medical procedure code specifically highlights that the healthcare provider has inserted or replaced a spinal neurostimulator generator.
CPT Codes for Acute Pain
Have you ever felt a sharp pain due to an illness, injury, trauma, or painful medical procedure? This type of intense pain is commonly known as acute pain. However, unlike chronic pain, acute pain lasts only for a short time and usually subsides when the underlying cause is addressed. Some key codes to address acute pain treatments include:
CPT Code 97124
Massage therapy is often a common treatment for acute pain. Healthcare providers use CPT code 97124 for this procedure. This code highlights one of the Physical Medicine and Rehabilitation Therapeutic Procedures. Physiotherapists use this code to claim reimbursements for their massage therapies. These massage sessions are usually measured in 15-minute units.
CPT Code 97810
Acupuncture is also often used to treat acute pain. CPT codes 97810 to 97814 address these procedures. CPT code 97810 in particular is used by healthcare providers to specify a 15-minute acupuncture session to relieve acute pain. This code indicates that the healthcare provider has used single-used metal needles to pierce the patient’s skin to stimulate anatomical points.
CPT Codes for Pain Management Procedures
Current Procedural Terminology (CPT) codes play a significant role in medical billing. They describe the performed diagnostic, medical, and surgical services. But what exactly is their framework for pain management services?
This is an important question because you can only provide quality patient care by receiving timely reimbursements through accurate coding. CPT codes for pain management procedures are divided into three categories.
Category I CPT Codes
From pain-preventing injections and nerve blocks to surgeries, category I of CPT codes covers most pain management services and procedures, including medical devices, drugs, and vaccines.
According to AMA, this primary group of CPT codes typically ranges from 00100 to 99499 and is further divided into different sections depending on the service type. Some common pain management procedures in category I of CPT codes include:
- Neurostimulators (CPT code 63650 – CPT code 63688)
- Nerve Blocks (CPT code 64405 – CPT code 64999)
- Epidural Steroid Injections (CPT code 62321 – CPT code 64484)
- Facet Joint Procedures (CPT code 64490 – CPT code 64636)
Category II CPT Codes
The second group of CPT codes is made up of supplemental codes. These alphanumeric CPT codes (four digits followed by an F) are not a primary part of medical coding. Instead, they are only used to track the services on medical claims for performance measurement. Some common examples of category II CPT codes include:
- Composite Measures (0001F – 0015F)
- Patient Management (0500F – 0584F)
- Patient History (1000F – 1505F)
- Physical Examination (2000F – 2060F)
- Diagnostic/Screening Processes or Results (3006F – 3776F)
Category III CPT Codes
The third category of CPT codes addresses new developments, including technology and services/procedures. These codes are also alphanumeric, like the second group of CPT. However, they are temporary.
The third group of CPT codes is mainly used for data collection, evaluation, and obtaining reimbursements for emerging services and technologies. In simple terms, they include services that are not covered by the first category of CPT codes. Some examples of these codes include:
- CPT Code 0869T (Specifies an injection containing bone-substitute material to fix bone and soft tissue hardware. This procedure might include intraoperative imaging guidance)
- CPT Code 0879T (Highlights the radiological data preparation and transmission procedure)
Pain Management Billing and Coding Guidelines
There are no set rules for pain management billing and coding. You just have to avoid the most common mistakes to get timely payments from the payer. However, it is easier said than done since complex pain management codes and ever-changing requirements make it difficult to succeed on the first try.
Instead of using codes solely based on their summaries, take some time to understand the essential pain management CPT codes. Improve the quality of your service and the financial health of your practice by following these simple tips:
- Document everything, from the patient’s medical history to diagnosis and performed procedures.
- Use proper pain management CPT codes depending on the type of pain and service.
- Report each unit of service. For example, massage therapy is measured in a 15-minute unit.
- Avoid common pain management coding errors by staying updated with the latest changes.
- Familiarize yourself with the payer’s policies and follow all the standard guidelines in the medical claims.
Conclusion
Medical coding and billing for pain management services is a complex process, mainly because of the annual updates and changes in the set of CPT codes. Therefore, it is quite challenging to avoid coding errors.
However, a professional medical billing company can help you with this process. If you don’t have the time to keep up with all the updates and dozens of pain management CPT codes, outsource pain management billing services to a reliable provider to obtain timely reimbursements.
