The pain management specialty has seen more than its share of coding and reimbursement changes throughout the past few years. 2015 brought another round of changes for this specialty: a major revision to a commonly used coding set, reimbursement rate changes, and bundling of needle placement guidance with joint injections, to name a few.
Other pain management procedures received an update in RVUs and reimbursement. Codes updated in the past were made to include imaging guidance, however in 2014 reimbursement was cut significantly. In 2015, the code’s RVUs have been brought back up similar to 2013 rates as discussed in the April 2015 issue of Healthcare Business Monthly, published by the AAPC.
You may wonder what has caused such major changes in the coding and reimbursement of interventional pain management procedures. The changes are preceded by improper payments dating back to 2006, when CMS and the OIG noted the increased spending in this area.
“Medicare Part B payments for facet joint injections increased from $141 million in 2003 to $307 million in 2006—a 76 percent increase in the number of Medicare claims for facet joint injections.”
Of these payments, CMS and the OIG recognized approximately $96 million in improper payments for the procedure. It is important to review the guidelines of your participating carriers, watching for differences in how they would like to see bilateral procedures, ie. modifier 50, or RT, LT. These guidelines will also provide the carrier’s specific medical necessity guidelines. Review the reimbursement you are receiving to be sure that add-on codes are not being discounted as other codes would be when billed with a 51 modifier, and that all units billed are being recognized by the carrier.