Pain Management Coding: Remember Uhc's Stance On Ablative Spinal Pain

By Author: Angela Martin
Total Articles: 206
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If your pain management practice participates with United Healthcare (UHC), you will want to take note of UHC's recent policy update on ablative treatment of spinal pain. Although UHC has a limited coverage policy for a number of spinal pain and facet joint pain procedures, you have some chance of reimbursement if you know the rules.

Ablation method and frequency matter

Among the changes are a revised coverage policy for how often thermal radiofrequency ablation (RFA) can be carried out and reimbursed. According to the policy, thermal RFA is covered when carried out at three months or greater frequency, provided there has been a 50 percent or greater documented reduction in pain.

Fluroscopic guidance required

Fluroscopic guidance is required when a physician carries out these procedures. The image guidance requirement makes sense. Per medical care standards, providers should not carry out the thermal destruction procedures ‘blind' or anatomically guided. Pulsed radiofrequency, other ablations not covered pain management practices ...
... that make use of emerging techniques to treat chronic spinal pain will also be in for some disappointments. The updated UCH policy considers pulsed RF therapy, cryoablation, alcohol ablation, and laser ablation to be unproven for spinal/facet joint pain and, as such, not covered.

Reasoning: Some people will try to bill the pulsed RFA using the normal CPT codes used for thermal RFA. The policy is stating it should be an unlisted code and they don't cover it.

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