According to the National Institute of Health, over 25 million adult Americans (about 11 percent of the population) suffer from chronic pain lasting at least three months or more. The Institute of Medicine estimates the financial impact of chronic pain exceeds some $600 billion annually in terms of treatment for pain management and lost productivity among those who suffer with chronic pain.
From a clinical standpoint for those providers who specialize in chronic pain, unlike most medical conditions, chronic pain can most frequently only be managed, not cured. Even more critical, in many cases, the cause of the patient's pain isn't always clear. Lastly, providers have a wide range of options for treatment, from the most aggressive to the most conservative approaches. Is it any wonder pain management remains one of the most difficult areas for accurate coding and reimbursement?
Here are some tips to prevent problems in your pain management charts:
Medical Document Accurately
This sounds deceptively simple but without precise and complete documentation, pain management procedures are extremely difficult for billing staff to code. Consider spinal decompression surgery for example: Each nerve that is surgically decompressed must be mentioned and documented carefully or revenue suffers. Similarly, generalization in the case of facet joint injections, for example, may result in over-coding and over payment, potentially triggering an audit.
In many cases, coding staff may need to educate providers on specific documentation needs so that procedures are adequately coded to ensure the highest possible reimbursement. It's often helpful to prepare examples of adequate and insufficient documentation for high-volume procedures for the providers to review to help prevent coding bottlenecks that hold up payment.
Also, be sure that coding staff is using the most up-to-date versions of LCDs and NCDs, as these guidelines are subject to frequent changes. The same is true for applying NCCI edits; some insurance carriers specify the edits they prefer into their contracts, and it's essential to understand the process they use for adjudicating pain management claims.
Show the Relationship Between Medical Documentation and Appropriate Coding
Getting recalcitrant physicians on board with any documentation changes necessary for adequate coding is a major challenge in many practices. To overcome resistance, it's helpful to show how bills that do not accurately reflect the treatment and procedures performed directly impacts revenue and ultimately physician compensation in many cases.
Don't forget to highlight the importance of documenting medical necessity, which many payers are prioritizing over diagnosis. Notes should document the amount of pain relief the patient has achieved, whether or not physical therapy was used, and the findings of any MRIs.
Projections that show the financial impact of under-coding a high-volume procedure over the course of a year, or reductions due to inadequate documentation, can be extremely effective on this point.
Take Advantage of EHR Efficiencies
While pain management practices are not as easily adapted to the drop-down menus that simplify document process today for many other specialties, it is possible to set up templates and other efficiencies that prompt providers to record all the relevant information.
Make sure work-flows are incorporated for high volume procedures such as trigger point injections, peripheral nerve blocks, radio frequency treatments, and discography, for example, and build anatomical diagrams for documenting sites of pain and therapeutic injection sites, and for annotating pain management procedures such as LESI and CESI.
For some practices, pain management billing and coding is more an art form than a discrete science, to the detriment of revenue cycle management. If your practice isn't achieving a satisfactory level of reimbursement for pain management services, contact us today for a free consultation.