Understanding the Importance of Accurate Pain Management Billing
Pain management is a complicated field of healthcare, making it challenging to perform accurate billing and coding for your healthcare services. Keep reading to learn how to reduce claim delays and denials and maximize reimbursement.
Pain Management Billing and Coding: What You Need To Know
Understanding pain management billing and coding is essential for your revenue cycle management (RCM). Otherwise, you expose yourself to payment delays, unstable cash flow, and claims denials—all of which are detrimental to your business’ financial health.
While proper billing and coding are critical for every medical practice, pain management is uniquely complex. Medical technology related to pain management is constantly advancing. This can make it challenging to keep track of new and changing current procedural terminology (CPT) codes and proper billing practices.
For example, the CDC recently released new guidelines that describe when and how medical practitioners should administer opioids for pain management. Old codes and procedures may no longer be applicable, and improper coding prevents you from receiving maximum reimbursement for your healthcare services.
High-Quality Care Requires Diligent Pain Management Billing
As a healthcare provider, you strive to provide outstanding patient care for chronic pain, illness, and injury. However, there are many ways to manage pain effectively and provide high-quality patient care. Often, these pain strategies work in tandem with each other, complicating the pain management billing process. Here are a few examples of some of the most common pain management tactics:
- Over-the-counter and prescription pain medicine: Non-steroidal anti-inflammatory drugs (NSAIDs), narcotics, and analgesics are commonly used to ease aching and reduce chronic pain.
- Physical therapy procedures: Massages, hydrotherapy, and exercise can relieve bodily stress and strengthen critical musculoskeletal processes.
- Psychological therapy: Cognitive behavioral therapy (CBT), relaxation techniques, and meditation are often used to ease the mind and strengthen the mind-body connection.
- Radiofrequency ablation (RFA): This practice is used to disable nerve fibers that transmit pain signals to the brain.
- Cortisone Injections: Cortisone shots are used to relieve pain and inflammation in a specific part of your patient’s body. They are commonly injected into joints, such as the ankles, knees, spine, or wrists.
- Surgery: Various surgical procedures are used to reduce the sensitivity of specific nerve endings to reduce the sensation of pain.
Although this is just a small sample of available pain management techniques, several strategies are often combined to provide effective pain management and relief. However, even after implementing an effective pain management strategy, you need to properly bill and code your healthcare services in order to receive reimbursement.
For example, if you give a patient a cortisone shot on both of their knees, you need to include modifier 50 in your pain management billing and coding. This modifier indicates that you performed a bilateral procedure, and including it affects your maximum reimbursement potential.
Proper pain management billing and coding is essential for receiving maximum reimbursement for your healthcare services. Explore our blog to learn more about how you can improve your revenue cycle management.
How Can You Be Sure You’re Following Pain Management Medical Billing Guidelines?
Performing proper pain management billing and coding is challenging, but with the right strategy, you can avoid errors and ensure maximum reimbursement for your services. Here are a few pieces of advice that can help you do so:
Avoid Billing Based on Summaries
To perform correct pain management billing and coding, you need to have a comprehensive understanding of the services provided to your patients. Many healthcare providers mistakenly bill procedures based solely on the report’s summary. Although the summary is an essential tool to begin understanding the treatment, you must read the entire report to include all necessary information and perform accurate billing and coding. Pain management is complex, so you need to ensure that related treatments are billed appropriately.
Address Errors in Medical Records Correctly
Proper documentation of medical records is essential for ensuring that payers pay for services. Mistakes in medical records are bound to happen at some point, but you need to know how to address them to bill for your services properly.
For example, if there’s an error in your patient’s records, you shouldn’t scratch it out or apply correction fluid. This can cause a claim delay or denial. To address the mistakes in medical records, physicians should:
- Draw a single line through the error.
- Label the mistake by writing “error” above the crossed-out section.
- Apply the correction.
- Initial the correction.
Keep an Eye Out for Canned Reports
Sometimes, physicians use report templates to describe a pain management treatment. Similar to the report summary, this contains only some of the information needed to properly bill and code for a treatment or procedure. Physicians should instead strive to write detailed reports tailored to each patient.
Know Your CPT Codes
CPT codes are updated every year, so you must stay up to date to consistently provide the correct documentation. You should always examine and verify the CPT codes in a report to ensure they accurately reflect the pain management services you provide to your patients. In addition, you also need to know how CPT codes interact—some can be bundled and billed jointly. For example, many providers inaccurately bill fluoroscopy separately from pain management. In reality, this procedure is included in many pain management CPT codes. Billing for it separately can create duplicate claims, leading to delays and denials.
Partner With a Reputable Medical Billing and Coding Provider
The most effective method for successful pain management billing and coding is outsourcing your billing and coding services to a reputable provider. Pain management is a complex healthcare field, and medical billing and coding providers have the industry experience to understand its many nuances.
These providers ensure that your pain management billing and coding is complete and accurate, reducing the possibility of delays and denials and maximizing your reimbursement.