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Pain management billing guidelines

How To Optimize Pain Management Billing Services

Pain Management Billing Guidelines

With millions of individuals in the United States suffering from severe and continuing pain – chronic pain management has emerged as a severe public health issue, costing the government billions of dollars in delayed time and productivity while significantly affecting people’s life. According to a CDC survey, approximately 50 million Americans suffer from chronic pain, which translates to 20.4% or 1 in 5 adults. Successful billing and coding are half the battle for increasing practice income. New state and federal rules have generated challenges for pain management billing.

Recently, pain management has been dealing with billing difficulties such as extending prior authorization requirements, lowering fee schedules, and transferring financial obligations to the patient. After recognizing and grasping these problems, there are guidelines to enhance your pain management billing collection.

Pain Management Documentation (PMD)

Medical documentation assures that every procedure is medically necessary. Likewise, pain management documentation (PMD) is essential for pain management treatment. It is a method for healthcare staff to communicate about patients’ issues, therapies, and reactions. Claim denials can be avoided with precise and detailed pain management documentation. Coders must be professional in clarifying information discovered in notes and coding correctly based on the most recent coding recommendations once they are given to the business department.

Correct Errors In Medical Records

Complete documentation is vital to ensure that payers pay for treatments and address medical record inaccuracies adequately. Physicians should never wipe out words or apply correction fluid within patient records. If a mistake is found in a patient’s medical history, a single sentence should be put across it in ink, the word “error” must be placed above it, and the repair should be done. It is also necessary for physicians to approve any correction made to the record.

Up To Date Payer Policies And Guidelines

Considering that there are hundreds of insurance companies, providers, and coders. It is critical to remain updated on insurance payer policy changes to maximize compensation, requiring investigative efforts to collect information from changes and documentation received from many payers. The most significant changes in coding and billing are generally disclosed in the fourth quarter of the preceding year, with effective dates of January 1st. However, information might change during the year. During the COVID-19 pandemic, for example, telemedicine adjustments influenced patient E/M codes and ICD-10-CM codes.

Maintaining compliance with payer regulations and billing guidelines will result in fewer denials and faster insurance payouts. In case of a problem, calling the insurance company may give more clarification and help you avoid late payments. Insurance firms routinely offer updated billing standards and policies on their websites and provider portals. You can remain updated with payer rules and norms by training your billing and coding staff.

Avoid Billing Procedures Based On Summaries

One of the most common errors in pain management billing and coding is charging a process based only on a summary. According to Medicare, you can only bill for operations detailed in the text of the report. It implies that programmers must go beyond an overview of the document for coding reasons.

Fluoroscopy Billing

The majority of pain management practices frequently make the error of charging fluoroscopy individually. Many pain management codes require fluoroscopy, such as discography, articular joint, spinal steroid injections, and radiofrequency ablations.

Make sure you grasp if there is a combined payment for the treatment used, such as SI joint (27096), medial branch blocks, and facet injections, or if it is recognized independently, such as fluoro guidance codes for peripheral joints. When you charge for fluoroscopy individually, your claims will be disallowed because they are duplicates.


Modifiers help clarify the process in-depth, and using incorrect modifiers may result in claim denials. Modifiers that are used primarily on pain management billing are as follows:

-LT stands for anatomically left; -RT stands for anatomically right.

50: Bilateral procedure

59: indicates that a service or operation is unique and distinct from other services provided on the same day

52: incomplete procedure; delaying part of the procedure for considerations other than patient well-being.

53: incomplete procedure; the physician decides to terminate the procedure for the patient’s safety.

Modifier -50 must be used when coding bilateral operations and denotes a procedure done on both sides of the patient’s body in a single session. Forgetting modifier -50 or coding each body side is a typical error.

Essential Points To Consider While Evaluating Pain Management Billing Services

  • Your claims should be managed by specialized processing professionals familiar with the pain management requirements of worker’s compensation.
  • The majority of delayed or refused claims are due to coding errors — A pain management billing specialist should understand and have experience with the specialized pain management codes.
  • Payer pre-authorizations should be acquired and kept on file until a new authorization is necessary for each procedure.
  • One of the most significant advantages of hiring a reputable medical billing service provider is that they understand and work closely with a range of payers and are familiar with their unique requirements.

A competent medical billing business should include extra services to handle your revenue cycles, such as A/R management for patients and coverage, modifications, and patient demographics. We have experience in pain management billing and coding solutions. We provide contracting and credentialing services. We guarantee proper code optimization and prevent denials. Contact us to find out how we can help you in pain management billing.

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