Pain Management Conference To Manage The Coding Woes

By Author: Julia Rose
Total Articles: 89
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It is of utmost importance to be specific with pain management coding because if the diagnosis codes are non specific then you are actually at the mercy of the service providers. This may be explained according to the Medicare Local Coverage Decision [LCD] or a third-party medical policy where you would be paid for any service which does not have an exact or specific code. No ‘close to; meanings would work. Further, it says that if you have been paid then it would mean you are paid for the service as an error. However in case the right diagnosis would have made then there would have been no coverage.


These third party payers now have a more stringent and strict criteria for the coverage and inclusion of therapies and procedures. And if you don't fall under them you definitely fall down, albeit financially.


It is needful to have a well documented record of the patient's diagnosis history so that coding becomes a spontaneous process. Now as a coder you need to balance out the situation and handle it ...
... correctly because if you falter at one point, the patient would face the brunt. So before coding for pain, it is advisable to look out for prior conditions of the patient's history which may have been aggravating his present situation. Suppose, there is a patient x who has a back pain due to some prior conditions then as a coder you have two options: Firstly you may code it as 338.21 — Chronic pain due to trauma, 723.1 — Cervicalgia, 905.1 — Late effect of fracture of spine and trunk. Alternatively, you may code it as 338.21, 723.1, and V15.51 - Personal history of injury-healed traumatic fracture.


Pain management coding has been going through a tide of modifications which every coder should be aware of. In case you need to be more specific and code your way to success then be there at the Pain Management Conference at Buena Vista Palace in Orlando, Florida on December 6-8, 2009