Attend Conferences And Do Away With Your Pain Management Denial Woes

By Author: Julia Rose
Total Articles: 89
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A chronic Patient A comes to a pain management specialist, but during the visit, the physician fails to uncover a definitive diagnosis. Although changing or doing guesswork of the diagnosis is not right, there are codes that can help you handle the situation.


It always pays to stay away from assumptions as much as possible. To cite an example, Patient A is complaining of severe, chronic pain in the right side of his back; the problem began about 10 months back. The pain management specialist performs an examination and then provides two trigger point injections in the right lumbar multifidus muscle for pain relief. But his chart notes show the patient has back pain.


You get this chart and note your physician performed trigger point injections on other patients in the past, using one unit of 20552. Let's say the most recent injections carried out on the other patients' backs were for myofascial pain.


As there's no specific diagnosis, will you assume the patient also has myofascial pain and report 20552 with a diagnosis of 729.1?


The answer is no because ...
... assumptions are not sufficient for coding compliance. If your physician did not specifically note myofascial pain or myalgia and you use one of these codes, you could land yourself in trouble in the wake of a payer audit.


Remember back pain (724.5) is not the same as myalgia (729.1). You can't choose myalgia just because it's close and is on the approved list.


If you want to be on top of your pain management coding, there are coding conferences to help you get there. When you attend one, you'll get pain management coding updates and learn to be more specific in your coding so that denials don't come anywhere near you.


Gain knowledge about medical coding by attending proper medical coding conferences along with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.