Pain Management Billing

Enlisting the assistance of professional medical billing companies is the preferred course for several pain management centers in order to assist in turning their revenue cycle management into a success. While the medical staff of a physician practice is skilled at assisting day-to-day activities in the clinic, or medical facility, other responsibilities in the job may hamper productivity when billing tedious pain management claims.

According to the Office of the Inspector General (OIG), pain management billing is one of the most erroneous in billing in the industry. This may be attributed to the fact that several claims have been overpaid or mistakenly coded due to an inconsistency in documentation.

A study released details of inappropriate Medicare payments for procedures in transforaminal epidural injection. As a result of these findings, pain management billing is always reviewed with a certain level of scrutiny to make sure that reimbursements are fair to both the pain management practice, and the insurer.

Pain management practices can be adversely affected by a streak of erroneous billing claims from most pain management practices. Experts always advise medical practices to perform self-audits, and ensure that all data submitted to the payer, or insurer is one hundred percent accurate. Most pain management practices assess their own practice in reviewing their office’s conformity with CMS guidelines for rendering pain management services.

Pain management offices compare their outputs and data to other medical offices with the use of the Comparative Billing Report (CBR). By looking into the averages on the CBR, pain management offices can perform a self-audit to check if they can justify the increased numbers on some claims. Auditors often use Comparative Billing Reports (CBRs) to identify red flags on a claim, or excessive claims coming from a medical practice.

Pain management centers are not the only medical practices that experience scrutiny from auditors. However, insurance payment auditors cannot discredit the fact that pain management claims have an elevated margin for error. Based on several sources, the technicalities of pain management billing always gets the best of clinicians. The list below shows common errors and tips for clinicians to accurately document CPT codes.

1. When performing bilateral procedures, always use Modifier -50

Modifier -50 is a HCPCS modifier that accompanies HCPCS codes to provide additional information regarding the procedure. Modifier -50 specifically represents a service or procedure that is performed on both sides of the body during the same session.Fluoroscopy cannot be billed separately on multiple occasions

2. Fluoroscopy cannot be billed separately on multiple occasions

Fluoroscopy is declared included on the CPT on these separate occasions:

• Transforaminal Epidural Steroid Injections (ESI)
• Intraarticular joint or medial branch block facet joint procedure
• Radiofrequency ablation
• Discography

3. Errors in billing fluoroscopy in pain management billing result in many billing errors, which results in duplicate claims made for the same procedure.

CPT codes provide accurate descriptions of the procedure. Performing an internal audit will expose areas for improvement to enhance accuracy in billing and preventing adverse auditing.

MPMR has extensive experience with pain management medical billing and has been working with both pain management practices and ambulatory surgery centers for over two decades. Not only does MPMR typically increase pain management practice revenue substantially, the company also offers credentialing and contracting too!