Opioid abuse is a hot headline topic, with concern growing over how many people are turning to opioids for pain management. As a result, payers have their eyes trained on pain management claims, regardless of subtopic. That’s why pain management coders need to up your game, now—especially with the release of 2019 ICD-10-CM and updated Current Procedural Terminology (CPT®) codes coming right around the corner.
In fact, as pain management coding specialist Amy Turner will explain in her coding webinars for ProfEdOnDemand, you have quite a few changes that will affect your practice in the upcoming fiscal year. During her November 2018 sessions on pain management, Turner will walk you through what has changed and why it matters, so you can do your job with ease. You’re the first line of defense for your medical practice, so this is the season to sharpen your coding know-how.
CPT®: Watch Intrathecal Drug Delivery Codes
It’s worth repeating that correctly submitted claims will keep your practice compliant with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—and ensure proper Merit Based Incentive Payments System (MIPS) reimbursement. This is an area where many coders struggle, which is why accurately coded claims and compliance are again a focus of the 2019 Coding Updates Virtual Boot Camp (VBC).
What to expect: CPT® coding updates don’t take effect until Jan. 1, 2019, and there are no published lists yet available of what changes are on the horizon; however, word has it that significant updates will include changes to advanced procedural coding for intrathecal pumps. So keep an eye on these codes in the coming months.
Here’s a list of the main current intrathecal drug delivery codes:
Implantation or Replacement
- 62350, implantation, revision, repositioning of tunneled intrathecal or epidural catheter, no laminectomy
- 62362, includes preparation of pump, with or without programming
Removal
- 62355, removal of a previously implanted intrathecal or epidural catheter
- 62365, removal of subcutaneous reservoir or pump
Electronic Analysis (includes evaluation of reservoir status, alarm status, drug prescription status)
- 62367, no reprogramming or refill
- 62368, with reprogramming
- 62369, with reprogramming and refill
- 62370, with a reprogramming and refill that requires the skill of a physician or other qualified healthcare professional
ICD-10-CM: Rest Easy This Year
As of now, there don’t appear to be any major changes to ICD-10-CM pain management codes, but that doesn’t mean you won’t need to prepare. Remember that there could be changes at any time—even after the Oct. 1, 2018 implementation deadline. And there’s always room to improve your knowledge of existing diagnosis coding best practices.
And Don’t Forget…The Physician Fee Schedule (PFS)
This past June, the Centers for Medicare & Medicaid Services (CMS) issued a Proposed PFS for 2019. Comments are open through September 10, 2018. Major changes include the suggestion to collapse payment levels from 5 to 2, creating one patient reimbursement level for new patients (CPT® codes 99202-99205) and one for established patients (99212-99215). Changes that would affect pain management specifically are:
- Increases for hip joint injection
- Decreases for codes regarding electronic analysis of programmable pump, suprascapular nerve blocks, and occcipital nerve blocks, among others
- Increases for spinal cord neuro-electrode placement
Be sure to take a look at the PFS for details on how your practice would be affected.
Safeguard Your Practice with Boot Camp Training
Given the busy nature of your practice, the increased scrutiny when it comes to pain management, and the changes to codes and the PFS, you have a lot ahead of you in the coming year. Don’t go it alone. This year’s 2019 Coding Updates Virtual Boot Camp is jam-packed with crucial, timely information to keep your coding on target and help you avoid common pitfalls while preparing you for what’s ahead.
