Pain management centers have a lot of space for expansion today. The American Academy of the reports from Pain Medicine, over 100 million Americans experience chronic pain. According to a new study by the Centers for Disease Control and Prevention (CDC), over 50 million people suffer from chronic pain. It equates to 20.4 % of the adult population, or 1 in every 5 people. This is way more than the total number of patients suffering from heart disease, diabetes, and cancer.

Although there is room for expansion, some of the pain treatment billing and coding issues make it difficult to succeed. Over here we will talk about some of the familiar mistakes and challenges in the Pain Management Billing and Coding system.

Avoid relying solely on summaries:

One of the major flaws in pain management billing and coding is to bill a procedure based only upon a summary. You are only allowed to charge for procedures that are reported in the body of a study, according to Medicare. This means that for coding purposes, coders must look past the report’s description at the beginning.

Delays in the administrative setup:

Numerous pain management billing practices handle claim denials by a time-consuming manual procedure performed by in-house employees. As a result, the re-submission takes longer and labor costs rise. Outsourcing pain management billing to a team of experts will boost claim rejection settlements, case mix performance and the time claims are in accounts receivable.

Inaccurate coding

Another expensive billing and coding error in pain treatment is simply listing codes issued by doctors in reports. Examining such records and ensuring that the codes effectively and reliably represent the physician’s services is what proper coding entails. It’s also crucial to double-check that the procedures being coded have proper documentation.

Billing Fluoroscopy in Pain Management Billing

Billing fluoroscopy separately is a common mistake in pain management billing and coding. Many pain relief codes include fluoroscopy, like:

  • Discography
  • Intra-articular joint
  • Medial branch block facet joint operations
  • Transformational epidural steroid injections
  • Radiofrequency ablations

Billing fluoroscopy separately often results in duplicate claims being submitted for a single procedure, resulting in expensive denials that impact the bottom line.

Modifier-50

Make sure to include modifier -50 when coding for bilateral procedures. This modifier adds additional detail about the operation being coded. Modifier -50 denotes a treatment or service that is conducted on both sides of the patient’s body in a single session. Unfortunately, forgetting modifier -50 or coding each side of the body separately is a common mistake.

So what’s the solution?

Hence to conclude, outsourcing to a professional medical billing and coding company helps solve this pain management billing problem. Make sure that the outsourcing partner has extensive experience with pain management billing services. Moreover, it should also be up to date and familiar with the recent changes and developments.