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Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative, "wear-and-tear" type of arthritis that occurs most often in people 50 years of age and older, although it may occur in younger people, too. In osteoarthritis, the cartilage in the knee joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful bone spurs. Osteoarthritis usually develops slowly and the pain it causes worsens over time. I know it can be hard to determine if your patient's injection would need a prior authorization or precertificaton. It is always best that we verify our patients' coverage, benefits and eligibility.  Blog Post: PRIOR AUTHORIZATION, PRECERTIFICATION & BILLING PROCESS FOR HYALURONAN ACID & VISCO THERAPIES FOR OSTEOARTHRITIS OF THE KNEE PRIOR AUTHORIZATION, PRECERTIFICATION & BILLING PROCESS - HYALURONAN ACID & VISCO THERAPIES FOR OSTEOARTHRITIS OF THE KNEE CPT CODES: 20605, 20606, 20610, 20611 HCPCS CODES: J7318, J7323, J7328, J3490, J7320, J7321, J7322, J7324, J7325, J7326, J7327, J7329, J7331, J7332 Let's look at a commonly published clinical policy and guideline for these visco and hyaluronan acid therapies. Pay attention to everything on this post because these can all be very helpful for your billing and in order to maximize reimbursement. Conservative Treatment: Physical therapy or pharmacotherapy/NSAIDs (e.g., non-steroidal anti-inflammatory drugs [NSAIDs], acetaminophen and/or topical capsaicin cream) Understanding Indications and Dosing: Intra-articular injections of sodium hyaluronate are proven and medically necessary when all of the following are met: 1. Diagnosis of knee osteoarthritis 2. Member has not responded adequately to conservative therapy which may include physical therapy or pharmacotherapy or injection of intra-articular steroids or member is unable to tolerate conservative therapy because of adverse side effects 3. The member reports pain which interferes with functional activities. --- ambulation, prolonged standing 4. The pain is attributed to degenerative joint disease/primary osteoarthritis of the knee. 5. There are no contraindications to the injections --- active joint infection, bleeding disorder 6. Dosing is in accordance with the US FDA approved labeling as follows. --- Durolane: Approved as a single injection --- Euflexxa: Approved for 3 injections --- Gel-One: Approved as a single injection --- Gelsyn-3: Approved for 3 injections --- GenVisc 850: Approved for 3-5 injections --- Hyalgan: Approved for 5 injections --- Hymovis: Approved for 2 injections --- Monovisc: Approved as a single injection --- Orthovisc: Approved for 3-4 injections --- Supartz: Approved for 3-5 injections --- Synojoynt: Approved for 3 injections --- Synvisc One: Approved as a single injection --- Synvisc: Approved for 3 injections --- Triluron: Approved for 3 injections --- TriVisc: Approved for 3 injections --- Visco-3: Approved for 3 injections Learn how to properly bill and report these HCPCS codes for maximized reimbursement. READ HERE!  Common Criteria and Utilization Limitations: Initial Determination: --- therapy has not resulted in functional improvement after at least 3 months Reauthorization/Continuation --- At least 6 months have passed since the prior course of treatment for the respective joint Intra-articular injections of sodium hyaluronate are unproven and not medically necessary for treating any other indication due to insufficient evidence of efficacy including, but not limited to the following: ----- Hip osteoarthritis ----- Temporomandibular joint osteoarthritis ----- Temporomandibular joint disc displacement Hyaluronic acid gel preparations to improve the skin's appearance, contour and/or reduce depressions due to acne, scars, injury or wrinkles are considered cosmetic and are not covered. Contraindications: 1. Do not administer to patients with known hypersensitivity (allergy) to hyaluronate preparations or allergies to avian or avian-derived products (including eggs, feathers, or poultry). This contraindication does not apply to Orthovisc. 1. Do not administer to patients with known hypersensitivity (allergy) to gram positive bacterial proteins. This contraindication applies to Orthovisc only. 1. Do not inject sodium hyaluronate into the knees of patients with infections or skin diseases in the area of the injection site or joint. Imaging Requirements: (MRI, CT, XRAY, U/S):X-ray, CT, or MRI reports), Color Doppler ultrasound (CDUS) and synovitis scores Pain Relief: Knee Osteoarthritis (OA) --- single 6 ml IA injection of hylan G-F 20 provided better pain relief over 26 weeks Sodium Hyaluronate Product Therapy Using Preferred Products (Durolane, Euflexxa, and Gelsyn-3) >>Medical notes documenting all of the following: --- Current prescription --- diagnosis of OA of the knee --- Conservative treatment tried for at least 3 months including response --- Signs and symptoms --- Current functional limitations --- Complete report(s) of diagnostic imaging (X-ray, CT, or MRI reports) --- Previous sodium hyaluronate treatment provided including the brand name of the drug, course of treatment, and response --- Dose, frequency, interval since previous sodium hyaluronate treatment --- Physician treatment plan  Medical Necessity Cross-over: M17.0 -- Bilateral primary osteoarthritis of knee M17.10 -- Unilateral primary osteoarthritis, unspecified knee M17.11 -- Unilateral primary osteoarthritis, right knee M17.12 -- Unilateral primary osteoarthritis, left knee M17.2 -- Bilateral post-traumatic osteoarthritis of knee M17.30 -- Unilateral post-traumatic osteoarthritis, unspecified knee M17.31 -- Unilateral post-traumatic osteoarthritis, right knee M17.32 -- Unilateral post-traumatic osteoarthritis, left knee M17.4 -- Other bilateral secondary osteoarthritis of knee M17.5 -- Other unilateral secondary osteoarthritis of knee M17.9 -- Osteoarthritis of knee, unspecified Learn how to Bill for HYALURONAN ACID & VISCO THERAPIES FOR OSTEOARTHRITIS OF THE KNEE References: Clinical Policies of Commercial Payers and Medicare from published in the public domains. CPT Codes are a trademark and owned by the American Medical Association. ICD-10 Code book of 2022.  
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Let's start with the PROS to why hire a Virtual Scribe?  Pros and Cons of Hiring Virtual Medical Scribes - GoHealthcare Practice Solutions Peace of Mind: Hiring a virtual medical scribes may alleviate some pressure on the healthcare professional and the patient. A doctor or other healthcare provider may put their full attention on patient care. A hired virtual medical scribes a professional that attends patient appointments with a doctor virtually, takes detailed notes, and creates detailed records of the visit. To save up doctors' time for direct patient care, they have a "virtual medical scribe" take care of their electronic medical records and clinical charting remotely. While this is going on, the Virtual medical scribe who was hired may take down all the pertinent data. Patients will feel more at ease knowing their doctor can devote full attention to them. Increased Perception of Privacy: A hired virtual medical scribe enables the doctor and patient to have privacy throughout the exam since the scribe is listening remotely. More privacy is provided, which is particularly welcome for patients uneasy about having a third set of eyes and ears in the room. If the patient feels comfortable, they will be more forthcoming about their symptoms, aiding in diagnosis and leading to better results. Fewer People to on-board: Having fewer personnel to implement is another crucial advantage of using a hired virtual medical scribe service. To make sure the rollout of your EHR goes off without a hitch, you'll need to train almost all of your employees on how to use it. To save time and effort, you may instead employ and educate a Virtual Medical Scribe who can translate complex medical jargon into language that everyone on the team can understand. Issues with Scheduling: The schedules of the practitioner and the scribe in a 1:1 or 2:1 relationship must be coordinated. The surgeon will be on their own as long as the scribe is away from the office for vacation or sickness. This issue is resolved when a Virtual Medical Scribe is used. Face-to-Face Interaction: One of the most significant factors to weigh while weighing the benefits and drawbacks of virtual medical scribes is the amount of face-to-face time they will spend with your patients. Patients still prefer face-to-face connections with medical professionals despite the increased use of telemedicine. Computer software cannot read a patient's mood like a hired virtual medical scribe. EMR experts: Many e-health record systems are now second nature to the Virtual Medical Scribe (EMRs). This motivates the Virtual Medical Scribe to coach doctors on EMR usage and template implementation. As a bonus, a Virtual Medical Scribe who is already acquainted with the practice's EMR may help train new personnel. The hired virtual medical scribe will help ease the learning curve for the new doctor in this manner.  Pros and Cons of Hiring Virtual Medical Scribes - GoHealthcare Practice Solutions Reduced Functional Creep: One of the most significant issues with onsite hired virtual medical scribe is the phenomenon known as "functional creep," which occurs when an employee's duties go beyond what was initially expected of them. Faithful and independent scribes may be given more challenging EHR responsibilities to accomplish while doctors concentrate on patient care. Without proper precautions, a doctor may be held legally responsible for malpractice if functional creep occurs in their practice. Fortunately, the distance between the hired virtual medical scribe and the doctor considerably reduces the functional creep danger. Several virtual scribing agencies purposefully restrict staff access to the information they need to complete medical documentation, eliminating room for functional creep. The Flexibility of Service: As they can work from anywhere, virtual scribes are an excellent option for medical facilities that are located in distant or rural areas where onsite scribes may be scarce. The scheduling challenges often associated with onsite medical scribes are mitigated by the availability of several online medical scribe services, which provide coverage on short notice for employees who are off sick or on vacation. When onsite scribes are in short supply, medical facilities in distant or rural areas might benefit significantly from the services of virtual scribes, who can work from anywhere in the world. Scheduling issues that come with employing onsite medical scribes are mitigated by many online medical scribe firms providing an on-demand covering for absences due to sickness or vacation. Reduced Intrusiveness: Since hired virtual medical scribe no longer need to physically be present in the exam room, patients report feeling more at ease throughout their appointments. According to some research, patient anxiety and reluctance to provide private information have been linked to the presence of in-person scribes. This feeling of intrusion is much mitigated when using an online scribe.  Cons of hiring Virtual Medical Scribes  Pros and Cons of Hiring Virtual Medical Scribes - GoHealthcare Practice Solutions Lack of Streamlined Workflow: It is common knowledge that we'll discover methods to automate various jobs as our technological capabilities increase. This is why many hospitals are switching to EHRs instead of continuing to use a hired virtual medical scribe. One of the major drawbacks of hiring Virtual medical scribes, in the eyes of many, is that a computer program can replace them. Each individual who has contact with a patient may share what they learn instead of relying on a central repository. This approach may compile and make data available to doctors and patients. Medical errors: The fact that hiring Virtual medical scribes is human is one of the major "cons" when weighing the benefits of using virtual medical scribes. Humans are fallible, and you want as few errors as possible to occur in the medical industry. When adding a medical scribe to the mix, there is an increased risk of information being lost in translation. Weary Patients: Finally, when weighing the benefits and drawbacks of using hired virtual medical scribe, it is important to remember that some patients may be hesitant to open up to a healthcare provider they haven't met in person. They may experience frequent anxiety when there is more than one person present. Lack of Standardized Training: While demand for scribes continues to rise, standardized training has not kept pace. Some private employment organizations require onsite and remote scribes to complete in-house training programs, but the federal government provides no oversight or guidance for these initiatives. The scribes themselves have a vast range of expertise. According to a recent survey, 22% of scribes have formal training or certification, while 44% have no such background. Band-Aiding the Larger Problem: Even though scribes often help doctors, they are essentially only a stopgap solution to the much broader documentation issue. Although scribes may help speed up the note-taking process, doctors are still responsible for entering the scribe's work into the electronic health record (EHR). It is time to reassess our strategy for assisting doctors with note-taking and recordkeeping. From the minute a patient comes through the door until the final entry in the electronic health record is entered, the insurance claim is submitted, or the medication is dispensed, our solutions must meet concerns about cost and data security. This resulted in the study's main conclusion: that different scribes recorded varied data regarding duplicate patient contacts. Possibility of stifling EHR advances: While working with scribes may benefit doctors and hospitals in the short term, in the long run, it may have the unintended consequence of slowing down advancements in electronic health record technology and perhaps putting patients in danger. Lack of oversight: It is human nature to be a little reserved when one cannot physically see the new team member. However, Virtual medical scribes are experienced professionals who thrive in quiet, self-contained workspaces where they can set their own pace. This independence and control over their working day keep them far more motivated and productive than they would be if they were forced to stick to the rules in a typical office. So this may not be the downside as thought. Lack of availability is another standard reservation: To combat this issue, it is essential to not only explain tasks clearly, give clear briefs, and lay out what the expectations about their capacity to support the will be from the very start, but also to let them know the actual hours in the day one requires them to be contactable.  Hiring an Efficient HIPAA Compliant Virtual Medical Scribes Virtual Medical Scribes: Understanding Telescribes and Remote Scribes Virtual Medical Scribes: Understanding Telescribes and Remote Scribes Virtual Medical Scribes: Understanding Telescribes and Remote Scribes A Virtual Medical Scribe is a professional who documents the patient's encounter with the physician, irrespective of the location and time. Remote Scribing comprises of a real-time working as a writer while connected to a doctor’s office who is attending a patient or performing a simple procedure on a patient in the office. The remote scribe can view and listen to the proceedings and must meticulously enter all the relevant data into the EHR. The scribe must be well versed in medical terminology and drug names and be computer savvy to quickly enter details while the doctor is attending to the patient. Remote scribing is a growing field essential to the healthcare industry's future. Whether someone wants a new career or a place to gain experience, remote scribing presents an exciting opportunity to learn and contribute to healthcare in various ways. Scribes ease the burden on healthcare teams, help medicine progress into the electronic age, and improve patient care. With the approval of the Texas Christian University's administration, the Virtual medical scribe was invented by John Geesbreght, which led to the recruitment of pre-med TCU students for the establishment medicine. Upon invention, the Virtual or tech-enabled-remote scribes proved to offer more ROI and benefit to doctors in 2019. The innovations of the remote scribing purported to elevate the natural conversation between a doctor and a patient and decode it into structural noted in the HER as an output. Through the year of 2019, there was a high demand for a high ratio of human in the loop are required earnestly. Tele-scribing is also about the execution of simple peripheral tasks. These domains generally appeal to medical technician investors and resemble the Alexa-like workflows that consumers experience at home. In practice, these workflows did not save much time and offered doctors a lot of ROI in 2019. Further, there are a lot of workflows that are best done in expert user interfaces. For example, imagine ordering a flight ticket through a phone tree voice interface.  Virtual Medical Scribes: Understanding Telescribes and Remote Scribes The role of a virtual scribe determines a smooth route for physicians to assess and evaluate patients comprehensively. This is accomplished by the detailed description of clinical synopsis documented by a respective virtual scribe assigned to a certain physician. These processes are performed under high-security parameters in a HIPAA-compliant data management center and are connected to examination rooms through secure internet and VoIP connections. Only a few companies are into this at the moment across the world. The services require a lot of compliance, most importantly HIPAA, since it deals with sensitive information and exposure to the clinic setting. Telescribes is almost like a doctor's assistant but works virtually for the doctor and is connected via webcam. The work usually happens when the doctor is in session, corresponding to business hours. Given their familiarity with medical reports, Telescribes can be a good alternative for medical transcriptionist although strenuous if the partake does not have a passion in the field.  Virtual Medical Scribes: Understanding Telescribes and Remote Scribes While Telescribes video promotes patient-doctor privacy, it also allows a live scribe to listen to and decode the conversation from a different room through a secure and easy-to-use app on a mobile tablet. The viewer will hear the dialogue between the doctor and patient as the video shows the remote scribe documenting the visit. Tracking information from doctor visits. Scribe works as an assistant to doctors and collects lab results on patient scribes are focused on patient interaction. In this example of a clinical scenario, one will see the documentation for subjective and objective patient data, including the HPI, ROS, Physical exam (PEx), Assessment, and Plan. Through this system, a remote scribe can easily fulfill different duties such as appointment scheduling, billing, phone call reception, and another sort of inquiries. They note down all the key points, which reduces the physician's additional time spent on notes and documentation. In the clinical setting, a virtual medical scribe may have more responsibilities since the pace is slower and patients are more likely to be stable. Some of these responsibilities include reporting the quality codes mentioned earlier and putting in orders and charges, all under the physician's close supervision, of course. This provides great exposure to medical decision-making for scribes seeking experience in advanced healthcare careers. Through tele-scribing and webcam, the scribe can know and see what tests physicians order for which symptoms and the variety of treatments they provide for different ailments and conditions. However, scribes are heavily used in the emergency department in a hospital setting, although some hospitals utilize them in other areas.  Virtual Medical Scribes: Understanding Telescribes and Remote Scribes Medical scribes can be considered paraprofessionals, making the job easy for doctors by watching and documenting doctor-patient encounters. Currently, there are Virtual Scribes present online and work for physicians. Scribes improve documentation. While being a Virtual Medical Scribe does not require one to attain a college degree, they should be well trained in speed typing, English language, grammar, medical coding, medical conversations, listening, analytical and reasonable skills, and software navigation skill. Working remotely, a medical scribe is a clinical experience through the tele-scribing system. A medical scribe performs a wide range of transcription-related tasks. A personal assistant to the physician performs electric record-keeping responsibilities for the physicians during patient encounters, ensuring the best patient care cannot be accomplished in time. Subsequently, computer competence is also an essential skill for virtual Medical Scribe jobs. It is important not only to be able to type at an above-average speed but to do so while multitasking. The profession needs one to be able to type, listen, and take notes as the physician bounces between dialogue with the patient while giving notes and findings in various parts of the chart. Conclusively, remote scribing is the process where the words and actions of a doctor, surgeon, nurse practitioner, or other medical professional are charted and documented. Medical scribing is an organized and well-esteemed fragment of the US healthcare system; personal assistant helps the physician deliver a high-quality healthcare system. Scribing in a clinic involves a more predictable setting, although sometimes it can be just as intense as in the ER. The benefits and drawbacks of scribing in each setting depend greatly on what one is seeking. Since a Virtual medical scribe works on the documentation of patients' records, the hospital offers scribes more action in which they can promote the work of the doctor. This provides a lot of flexibility in scheduling. They must be quick and not miss out on critical data, as everything happens in real time. The ability to comprehend and good writing abilities all come in handy. Virtual Nurse RX has a team of registered nurses who can help one run a more efficient practice. The virtual scribes are a vital asset to the team by watching and listening to the patient's needs. A medical scribe is a person who assists doctors in charting prescriptions and adding data to EHR. Virtual Medical Scribes: Understanding Telescribes and Remote Scribes Billing Coding Knee Injection Hyalgan, Supartz, Visco, Genvisc, Synvisc - J7325, J7321, J7328 206107/13/2022 BILLING CODING KNEE INJECTION HYALGAN, SUPARTZ, VISCO, GENVISC, SYNVISC - J7325, J7321, J7328 20610 To all my blog readers that still are confused on how to properly bill, code and report these services. BILLING CODING KNEE INJECTION HYALGAN, SUPARTZ, VISCO, GENVISC, SYNVISC - J7325, J7321, J7328 20610 and more J-codes!  Osteoarthritis of the Knee HCPCS Code Billing Unit Drug Name(s)Dosing frequency per series (per knee) *Dose (per knee) *Units per dose (per knee) The following HCPCS codes are per dose codes: J7321 per dose Hyalgan 3 to 5 weekly injections 20 mg once weekly ( 1 unit per knee ) J7321 per dose Supartz 3 to 5 weekly injections 25 mg once weekly ( 1 unit per knee ) J7321 per dose Visco-3 3 weekly injections 25 mg once weekly ( 1 unit per knee ) J7323 per dose Euflexxa 3 weekly injections 20 mg once weekly ( 1 unit per knee ) J7324 per dose Orthovisc 3 to 4 weekly injections 30 mg once weekly ( 1 unit per knee ) J7326 per dose Gel-One Single injection** 30 mg x 1 dose ( 1 unit per knee ) J7327 per dose Monovisc Single injection** 88 mg x 1 dose ( 1 unit per knee ) HCPCS Code Billing Unit Drug Name(s)Dosing frequency per series (per knee) *Dose (per knee) *Units per dose (per knee) The following HCPCS codes are per mg codes (not per dose): J7328 per 0.1 Gelsyn-3 3 weekly injections 16.8 mg once ( 168 units per knee ) J7329 per 1 mg TriVisc 3 weekly injections 25 mg once weekly( 25 units per knee ) J7318 per 1 mg Durolane Single Injection** 60 mg x 1 dose ( 60 units per knee ) J7320 per 1 mg Genvisc 850 3 to 5 weekly injections 25 mg once weekly ( 25 units per knee ) J7325 per 1 mg Synvisc 3 weekly injections 16 mg once weekly ( 16 units per knee ) J7325 per 1 mg Synvisc-One Single injection** 48 mg x 1 dose ( 48 units per knee ) J7322 per 1 mg Hymovis 2 weekly injections 24 mg once weekly ( 24 units per knee ) J7331 per 1 mg Synojoynt 3 weekly injections 20 mg once weekly ( 20 units per knee ) J7332 per 1 mg Triluron 3 weekly injections 20 mg once weekly ( 20 units per knee )  Anatomy of the Knee These injections are crossing over to primary: OA (eg. M17.0) and secondary: Knee Joint Pain (M25.561, M25.562) CPT Codes: 20610 (unilateral), add 77002 if you perform under Fluoroscopy 20611 (unilateral) - if you perform under ultrasound If the injection is for Therapy. Make sure you document your notes as follows (example): 1/3 - 1st Injection 2/3 - 2nd Injection (append modifier EJ) for the drug code 3/3 - 3rd Injection (append modifier EJ) for the drug code Reference Source: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=55036&ver=59
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee CPT 2022. CPT is a trademark and owned by the AMA - American Medical Association.  CPT Codes to Report (based on Medical Necessity and Service(s) Performed: 63650 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL 63655 LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL 63663 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED 63664 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED 63685 INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING  REMEMBER: to always review documentations and medical necessity when performing these services. According to CMS Utilization Guidelines: Utilization Guidelines (most commercial payers also follow this guidelines): 63650 - Two temporary spinal cord stimulator trials per anatomic spinal region (two per DOS) or (four units) per patient per lifetime (with exceptions allowed for technical limitations for the initial trials or for use of different modalities of stimulation, including new technology), in place of service office, ASC, out-patient hospital, or hospital. Since permanent neurostimulator arrays can also be placed percutaneously, code 63650 can be covered more often in place of service ASC, out-patient hospital, or hospital. 63655 - One permanent spinal cord stimulator per patient per lifetime and must be performed in an ASC, out-patient hospital or hospital. 63663 - Will not be reimbursed in the office setting since they are included in 63650. Remember: The imaging guidance is NON-BILLABLE! Common ICD-10 Codes Cross-over meeting Medical Necessity: M51.16 Intervertebral disc disorders with radiculopathy, lumbar region M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region M51.24 Other intervertebral disc displacement, thoracic region M51.25 Other intervertebral disc displacement, thoracolumbar region M51.26 Other intervertebral disc displacement, lumbar region M51.27 Other intervertebral disc displacement, lumbosacral region M54.11 Radiculopathy, occipito-atlanto-axial region M54.12 Radiculopathy, cervical region M54.13 Radiculopathy, cervicothoracic region M54.14 Radiculopathy, thoracic region M54.15 Radiculopathy, thoracolumbar region M54.16 Radiculopathy, lumbar region M54.17 Radiculopathy, lumbosacral region M54.18 Radiculopathy, sacral and sacrococcygeal region M96.1 Postlaminectomy syndrome, not elsewhere classified Medicare and Most PAYERS DO NOT reimburse for the Leads. So be careful not to report the L-Code not unless you know your payer will pay for it! Reference: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57792&ver=6 CPT CODE BOOK: 2021 and 2022 ICD-10 GUIDELINE: 2021 CPT is a Trademark and Owned by the American Medical Association SCS Vendors Useful Links: Boston Scientific Interventional Pain Management Products Medtronic Spinal Stimulation Systems NALU NeuroStimulation St. Jude Medical NeuroStimulation Systems (Abbott) CPT CODES for NERVE BLOCK INDICATED FOR CHRONIC PAIN MANAGEMENT (SEE LIST BELOW) 62281 INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS), WITH OR WITHOUT OTHER THERAPEUTIC SUBSTANCE; EPIDURAL, CERVICAL OR THORACIC 62320 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITHOUT IMAGING GUIDANCE 62321 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT) 62324 INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITHOUT IMAGING GUIDANCE 62325 INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT) Do not report the imaging separately if the description says "with imaging guidance (i.e. Fluoroscopy or CT). Do not separate the code with any modifier, it won't work! you will not get paid and its non-compliant for lack of medical necessity!  64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE 64408 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; VAGUS NERVE 64415 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS 64417 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE 64418 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SUPRASCAPULAR NERVE 64420 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, SINGLE LEVEL 64421 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64425 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES 64430 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PUDENDAL NERVE 64435 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PARACERVICAL (UTERINE) NERVE 64445 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE 64446 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT) 64447 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE 64448 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT) 64449 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; LUMBAR PLEXUS, POSTERIOR APPROACH, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT) Reader's Question: How do I code and Bill for Cluneal Nerve Block and Cluneal Nerve Ablation or RFA? According to the AMA, the code series for medial branch blocks and the facet joint injections are the same (i.e., CPT series 64490-64495), with reporting based on the number of facet joints injected, not the number of nerves injected. For example: If three (3) medial branch nerves are injected only two (2) facet joint injection codes would be reported despite the fact that three nerves were injected, since each facet joint is connected to two medial nerves. The lateral branch nerve is a peripheral nerve and would be reported with CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch, when a lateral branch / peripheral nerve block is performed. So therefore, since the Cluneal Nerve are considered Lateral, Peripheral Nerves – it is just appropriate to assign CPT Code 64450 when blocking these nerves and CPT Code 64640 for the Destruction. 64450 INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH 64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH CPT code 64450 should only be reported per nerve or branch and not per injection. Make sure you read your Physician’s Op-report.Documentation must clearly indicate the nerve injected and the substance administered. Guidance: 76942 ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE), IMAGING SUPERVISION AND INTERPRETATION How about the Fluoroscopic Guidance? Can you bill for the CPT Code 77002? – NO. The CPT Code 77002 is now an ADD-On code per AMA’s CPT Guideline. There are codes that you can only bill with CPT 77002. According to the AMA CPT: CPT Code 77002 – Fluoroscopic guidance for needle place (eg. biopsy, aspiration, injection, localization device) (List separately in addition to code for Primary Procedure). (See appropriate Surgical Code for Procedure and Anatomic Location) Use 77002 as an “add-on” code with 10022, 10160, 20206, 20220, 20225, 20520, 20525, 20526, 20550, 20551, 20552, 20553, 20555, 20600, 20605, 20610, 20612, 20615, 21116, 21550, 23350. 24220, 25246, 27093, 27095, 27370, 27648, 32400, 32405, 32553, 36002, 38220, 38221, 38505, 38794, 41019, 42400, 42405, 47000, 47001, 48102, 49180, 49411, 50200, 50390, 51100, 51101, 51102, 55700, 55876, 60100, 62268, 62269, 64505, 64508, 64600, 64505) The cluneal nerves are sensory, not motor, and are divided into three lateral branches: inferior, medial, and superior (see below) 64450 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH 64451 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; NERVES INNERVATING THE SACROILIAC JOINT, WITH IMAGE GUIDANCE (IE, FLUOROSCOPY OR COMPUTED TOMOGRAPHY) 64461 PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SINGLE INJECTION SITE (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED) 64462 PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SECOND AND ANY ADDITIONAL INJECTION SITE(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64463 PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; CONTINUOUS INFUSION BY CATHETER (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED) 64479 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC, SINGLE LEVEL 64480 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64505 INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION 64510 INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC) 64517 INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC PLEXUS 64520 INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC) 64530 INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORING 64620 DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE 64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH  We are one of the exhibitors at the 19th Annual Spine, Orthopedic + Pain Management-Drive ASC Conference on June 16 to June 18, 2022 in Chicago! Please visit us out at table #70T. I am ready to answer all your questions and concerns about practice management, operations, compliance, coding, billing and payers' clinical & reimbursement necessity guidelines for Pain and Orthopedic cases. #beckers19thannualconference #painmanagement #spineconference #beckers2022spineconference #beckers19thannual #compliancemanagement #healthcarepracticeconsultant #coding  BECKER'S SPINE, ORTHOPEDIC + PAIN MANAGEMENT-DRIVEN ASC 19TH ANNUAL CONFERENCE - June 16 - June 18, 2022 in Chicago!    Looking forward to this event!!!  From your Team at GoHealthcare Practice Solutions!   ASIPP 2022 ANNUAL MEETING IN CAESARS PALACE IN LAS VEGAS MAY 5 TO 7 2022 
American Society of Interventional Pain Physicians 2022 Annual Meeting American Society of Interventional Pain Physicians 24th Annual Meeting CATEGORY 1 CREDIT The Institute for Medical Studies designates this live activity for a maximum of 24 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians of Osteopathic Medicine: The American Osteopathic Association (AOA) accepts AMA PRA Category 1 Credits™ as AOA Category 2-B credit. RN, NP, AND PA CREDIT Nurse Practitioners: The American Academy of Nurse Practitioners (AANP) accepts AMA PRA Category 1 Credits™ from organizations accredited by the ACCME. RNs/ APNs: Most State Nursing Boards accept CE activities designated for AMA PRA Category 1 Credits™ towards relicensure requirements. Check with your board to determine whether they will accept this CME activity towards your re-licensure. This activity is designated for up to 24 AMA PRA Category 1 Credit(s)™ Physician Assistants: The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credits™ from organizations accredited by the ACCME. SOURCE (FOR COMPLETE INFORMATION) PLEASE VISIT: https://registration.socio.events/e/asipp24thannualmeeting Looking forward to see everyone at this event!  From your Team at GoHealthcare Practice Solutions!  Anesthesia DELETED Codes 01935, 01936 in 2022 and Welcome New Codes 01937, 01938 Pay Attention to these Anesthesia codes from January 1, 2022. Deleted Anesthesia Codes 01935 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic (5 base) 01936 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic (5 base) New Anesthesia Codes In their place are 6 new (more granular) codes. Ideally, you should have begun submitting these to payers on January 1st. However, if your billing and/or coding platform wasn’t updated in time, you can always run a report to identify such cases, so that you’re able to resubmit corrected claims. As you’ll notice, anesthesia providers effectively lost one base unit per case on most of these procedures, due to revaluation. New Anesthesia Codes 01937 Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic (4 base) 01938 Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; lumbar or sacral (4 base) 01939 Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; cervical or thoracic (4 base) 01940 Anesthesia for percutaneous image-guided destruction procedures by neurolytic agent on the spine or spinal cord; lumbar or sacral (4 base) 01941 Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; cervical or thoracic (5 base) 01942 Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral (5 base) New Anesthesia Flat Fee Codes There were also two new neurolytic procedure codes and one new TEE code added for reporting. These are “flat fee”, non-time-based procedures. Anesthesia DELETED Codes 01935, 01936 in 2022 and Welcome New Codes 01937, 01938 for Pain Management Procedures! Sharing to you all pain management billing codes we have been utilizing helping our pain practice offices, surgery centers and our physicians clients! Let me know if you have any questions, concerns or confusion on how to report these codes properly. We have been in this world of Pain Management Practice Operations and Documentation for more than 20 years! The truth is, Pain Management billing codes are not easy to utilize if you don't know how to use them. It is always useful that you understand your physicians documentations and their procedures. Most of these codes are unilateral. Most of these codes are based on utilization and frequency guidance. So make sure you know all your payers guidelines for clinical and reimbursement. Let me know if you need me! But here are you codes!  Pain Management Billing Codes | GoHealthcare Practice Solutions Epidural Steroid Injections for Pain Management Billing Codes: 62321 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT) 62323 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT) Epidural Steroid Injections for Pain Management Billing Codes: 64479 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC, SINGLE LEVEL +64480 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64483 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, SINGLE LEVEL +64484 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Facet Joint Injections and Medial Branch Blocks Pain Management Billing Codes 64490 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL +64491 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) +64492 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64493 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL +64494 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) +64495 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Insurance Prior Authorization Services, Patients Access and Medical Documentation Reviews and Audits. Facet Joint Radiofrequency Neurotomy Pain Management Billing Codes 64633 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE FACET JOINT +64634 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64635 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT +64636 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)  Pain Management Billing Codes | GoHealthcare Practice Solutions Peripheral Nerve Blocks Pain Management Billing Codes 64400 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRIGEMINAL NERVE, EACH BRANCH (IE, OPHTHALMIC, MAXILLARY, MANDIBULAR) 64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE 64415 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS 64416 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT) 64417 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE 64418 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SUPRASCAPULAR NERVE 64420 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, SINGLE LEVEL +64421 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64425 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES 64430 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PUDENDAL NERVE 64445 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE 64446 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT) 64447 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE 64448 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT) 64449 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; LUMBAR PLEXUS, POSTERIOR APPROACH, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT) 64450 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH 64454 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED 64455 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PLANTAR COMMON DIGITAL NERVE(S) (EG, MORTON'S NEUROMA) 64624 DESTRUCTION BY NEUROLYTIC AGENT, GENICULAR NERVE BRANCHES INCLUDING IMAGING GUIDANCE, WHEN PERFORMED 64620 DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE 64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH 64999 UNLISTED PROCEDURE, NERVOUS SYSTEM Related Imaging Pain Management Billing Codes: 76881 ULTRASOUND, COMPLETE JOINT (IE, JOINT SPACE AND PERI-ARTICULAR SOFT-TISSUE STRUCTURES), REAL-TIME WITH IMAGE DOCUMENTATION 76882 ULTRASOUND, LIMITED, JOINT OR OTHER NONVASCULAR EXTREMITY STRUCTURE(S) (EG, JOINT SPACE, PERI-ARTICULAR TENDON[S], MUSCLE[S], NERVE[S], OTHER SOFT-TISSUE STRUCTURE[S], OR SOFT-TISSUE MASS[ES]), REAL-TIME WITH IMAGE DOCUMENTATION 76942 ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE), IMAGING SUPERVISION AND INTERPRETATION 76999 UNLISTED ULTRASOUND PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL) 97032 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES 97139 UNLISTED THERAPEUTIC PROCEDURE (SPECIFY) G0282 ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN DESCRIBED IN G0281 G0283 ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE Pain Management Billing Codes for Spinal Cord Stimulators for Chronic Pain 63650 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL 63655 LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL 63663 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED 63664 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED 63685 INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING Pay Attention to Medicare's Utilization Guidelines. This is also being utilized by most payers! 63650 - Two temporary spinal cord stimulator trials per anatomic spinal region (two per DOS) or (four units) per patient per lifetime (with exceptions allowed for technical limitations for the initial trials or for use of different modalities of stimulation, including new technology), in place of service office, ASC, out-patient hospital, or hospital. Since permanent neurostimulator arrays can also be placed percutaneously, code 63650 can be covered more often in place of service ASC, out-patient hospital, or hospital. 63655 - One permanent spinal cord stimulator per patient per lifetime and must be performed in an ASC, out-patient hospital or hospital. 63663 - Will not be reimbursed in the office setting since they are included in 63650. Insurance Prior Authorization Services, Patients Access and Medical Documentation Reviews and Audits. Pain Management Billing Codes for Kyphoplasty and Vertebroplasty 22510 PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; CERVICOTHORACIC 22511 PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBOSACRAL +22512 PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL CERVICOTHORACIC OR LUMBOSACRAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 22513 PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; THORACIC 22514 PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBAR +22515 PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Botox and ChemoDenervation Pain Management Billing Codes 64612 CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE, UNILATERAL (EG, FOR BLEPHAROSPASM, HEMIFACIAL SPASM) 64615 CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL, TRIGEMINAL, CERVICAL SPINAL AND ACCESSORY NERVES, BILATERAL (EG, FOR CHRONIC MIGRAINE) 64616 CHEMODENERVATION OF MUSCLE(S); NECK MUSCLE(S), EXCLUDING MUSCLES OF THE LARYNX, UNILATERAL (EG, FOR CERVICAL DYSTONIA, SPASMODIC TORTICOLLIS) 64617 CHEMODENERVATION OF MUSCLE(S); LARYNX, UNILATERAL, PERCUTANEOUS (EG, FOR SPASMODIC DYSPHONIA), INCLUDES GUIDANCE BY NEEDLE ELECTROMYOGRAPHY, WHEN PERFORMED 64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH 64642 CHEMODENERVATION OF ONE EXTREMITY; 1-4 MUSCLE(S) 64643 CHEMODENERVATION OF ONE EXTREMITY; EACH ADDITIONAL EXTREMITY, 1-4 MUSCLE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64644 CHEMODENERVATION OF ONE EXTREMITY; 5 OR MORE MUSCLES 64645 CHEMODENERVATION OF ONE EXTREMITY; EACH ADDITIONAL EXTREMITY, 5 OR MORE MUSCLES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64646 CHEMODENERVATION OF TRUNK MUSCLE(S); 1-5 MUSCLE(S) 64647 CHEMODENERVATION OF TRUNK MUSCLE(S); 6 OR MORE MUSCLES HCPCS Pain Management Billing Codes for Botox and Chemodenervation J0585 INJECTION, ONABOTULINUMTOXINA, 1 UNIT J0586 INJECTION, ABOBOTULINUMTOXINA, 5 UNITS J0587 INJECTION, RIMABOTULINUMTOXINB, 100 UNITS J0588 INJECTION, INCOBOTULINUMTOXIN A, 1 UNIT Insurance Prior Authorization Services, Patients Access and Medical Documentation Reviews and Audits. Insurance Prior Authorization Services, Patients Access and Medical Documentation Reviews and Audits.  Ways Patient Education Improves Safety and Quality of Care
Patients who participate in their own care are likely to have improved outcomes. Patient education is one way of facilitating self-management in patients with chronic diseases. Because patients often do not receive enough information about how their disease affects them, the information they know may be incomplete or inaccurate. For example, they may simply recall that diabetes causes excessive thirst; however, the main problem for type 2 diabetics is high blood glucose levels (hyperglycemia), which can damage organs and tissues throughout the body when it is not managed well over time. Patients need more than just recognition of these problems—they also need accurate guidance on how to control hyperglycemia through proper diet, medication use, exercising regularly, and other health maintenance activities. Patients tend to receive less information than they wish about their health, and yet they experience a discrepancy between what health care providers tell them and what they actually do. Patients tend to recall much more information than physicians think that patients know, but patients typically only remember about fifty percent of the information provided by physicians. Physicians may therefore underestimate how much patients can learn from brief patient education visits. Additionally, when patients fail to follow physician instructions during these short patient education sessions, physicians may conclude that such educational efforts are ineffective in promoting self-care or compliance with treatment regimens. Physicians should instead realize that manipulation of a treatment regimen for a single visit is not a reasonable basis for concluding a patient failed to understand it. Furthermore, discrepancies between what doctors say and what patients do can be reduced in short patient education sessions when the physician clearly explains the rationale for each instruction (i.e., why it is important). Patients are more likely to engage in health-promoting behaviors if they feel involved in decision making with physicians. These decisions may involve medical necessities versus options, cost versus benefit analyses of treatment plans, limitations on lifestyle choices (like diet or exercise), and other kinds of values-based choices that guide clinical decision making. Patient involvement does not predict how well people will follow care recommendations but does predict greater satisfaction with the type of information provided during patient education. Patients who feel involved in their care have better perceptions of communication with their providers, higher quality relationships with providers, perceive better quality of care, and are more satisfied with their medical visits. Patient involvement is related to perceptions about treatment effectiveness, understanding of health information, confidence in ability to manage one's health, participation in making decisions about one's own health care, trust in the competence of one's physician or other providers, accountability for choices made regarding treatment options, satisfaction with the relationship with providers (including how well providers listen), and willingness to seek additional help when needed. Physicians should try to elicit patient opinions before presenting an instruction plan rather than simply giving instructions that patients may perceive as insensitive or overly directive. The goals of patient education are usually developed by consensus between patients and healthcare professionals; however, differences exist between what doctors believe they want or need to tell patients and what patients actually want or need to learn. Studies of patient education suggest that people desire information about the following seven general topic areas: Patients can be taught about their condition by using written materials, pictures, demonstrations, group classes, or individual sessions with physicians. Most often, written materials are used for brief patient education episodes under ten minutes in length; however, they may also be useful for complex conditions requiring several hours of instruction over several visits. Patient education is sometimes compared to other methods of explaining health problems to patients (e.g., telemedicine), but it is not interchangeable with these approaches. During patient education interactions with doctors and nurses, patients should participate as much as possible—and doctors and nurses should encourage such participation. Patient education may be most effective when physicians establish a trusting relationship with patients before providing instruction. Patients can receive patient education either as an individual or by attending group sessions. When taught individually, the patient's concerns and expectations guide what information is conveyed; for example, older people tend to request information about medication side effects (possibly due to co-existing conditions), whereas younger people more frequently ask about the disease itself and how it is treated. More than 30 different types of health topics can be covered during short patient education sessions lasting ten minutes or less: these topics may include medications, medical tests and procedures, self-care issues (e.g., exercises), lifestyle changes that affect risk factors for certain medical conditions, and health care prevention practices. Patients can also receive patient education through group sessions led by professionals or other patients who have already received the same instruction. Patients should receive training in learning styles (e.g., auditory, visual, tactile) to help accommodate their preferred methods of receiving information. Group sessions are considered especially effective for teaching health-related behaviors that involve independent action on the part of patients (e.g., diet modifications). People attending group instruction may be more satisfied with what they learn than those receiving individualized instruction because group members can discuss concerns with each other; complementary questions even among different participants during presentations make it easier for presenters to cover all relevant material. Most people prefer short courses of only 1–2 hours in which they can see results of their learning immediately. Patients may learn more from patient education sessions when food, drinks, and distractions are prohibited or minimized. Pop-up windows with Internet links to educational materials have been found to contribute to patients' understanding of medical information discussed during patient education sessions. In a survey of doctors and nurses who had long experience providing patient education, the most important factors for a good outcome were thoughtfulness on the part of the practitioner (e.g., spending time building rapport before giving instruction), using relatively simple language (rather than "medical jargon"), and tailoring information to the individual's situation (e.g., consulting with him or her about lifestyle changes). Doctors and nurses should assess whether their teaching is successful when patient education ends. Patients who are taught certain skills that can be used in everyday life may have less need for visits with doctors in the future—especially when they are given general health information rather than specific instructions on how to address a particular medical condition (e.g., diabetes). However, some patients receiving patient education may want to make more frequent appointments with their physicians in order to discuss issues raised during these sessions. For people who already have chronic conditions, intensive training in self-care practices is required to produce changes that persist over time; such education needs to be continued long after each session of instruction or it will likely fail. To ensure that patients remember new knowledge and skills, short reminders of these should be provided by phone, e-mail, or postcard every 3–6 months after patient education. Mass media campaigns often provide instruction on screening tests for conditions with high prevalence. They raise awareness of the importance of health promotion activities and help people make decisions about cancer prevention or cardiovascular disease prevention strategies. However, it is difficult to ensure that those who actually need such testing take action because many do not recognize their personal risk factors for certain medical conditions (e.g., lack of regular physical activity). The effects of mass media campaigns on consumption of appropriate preventive services may be affected by characteristics such as race/ethnicity and socioeconomic status; thus, campaign messages should be tailored to specific target audiences in order to maximize their effectiveness. Patient education can be delivered via different media. For example, written materials are usually aimed at the general public and may be as simple as a brochure or as complex as a multivolume textbook. In some countries, primary care providers receive instruction from professional associations on how to provide patient education in settings such as nursing homes or outpatient clinics. A 2010 Cochrane review found that written materials were more effective than no intervention for preventing health problems among people with chronic conditions but not more effective than lectures although both were equally effective for improving physical function among the elderly. Patient education through audiovisual aids (e.g., video tapes) is considered particularly useful when training medical students who must learn diagnostic tests (e.g., mammography); however, it has not been shown to improve medical outcomes. Interactive CD-ROMs and DVDs that allow users to view material on their own schedules and learn at a pace that is appropriate for them may be useful for patient education and training, although they can also lead to many problems. For example, poor interface design (e.g., too much text with few visual aids) may result in people not learning the information as intended by the designers of the materials. In some settings, videoconferencing has been used as a means of providing patient education as well as consultations about medicine taking among international patients visiting Australia from other countries. Edwin Pritchard Eng, who coined the term "patient empowerment" in 1978, argued 25 years later that this term should be changed to "patient education" rather than empowerment because it is unlikely that people who lack the knowledge necessary to participate fully in their health care will become empowered as a result. Patient education can have negative effects on patient's health if the information provided is wrong, not enough or too much information. Negative effects of patient education can occur when a doctor gives a brief overview of a disease and its associated treatment without going into detail about the risks and benefits of each option. This may leave patients confused and unable make an informed decision about their treatment plans. If done properly however, patient education can improve communication between doctors and patients by providing accurate information as well as increasing awareness for preventative care techniques such as dieting and exercise regimes. The World Health Organization has identified several areas in which patient education and empowerment can improve populations' health: Patient empowerment is a term commonly used for describing the change of focus from passive treatment to active participation by patients. This usually means that patients need to take more responsibility for their own health, but it may also involve greater choice about different treatments (e.g., alternative medicine versus conventional medicine). In such cases, patient education forms an important part of the process because most people do not automatically know how to make informed decisions about their health care or resources they may use to help themselves. However, there is no consensus definition for this term; some definitions seem to include many elements of patient education while others may exclude these. Some definitions, for example, refer to patients having the authority to make decisions about their own health care without any reference to levels of literacy or education. In writing about empowerment and patient education in health care settings, the Indian authors Sivakumar Bose and Rajkumar Venkatesan wrote that empowering patients can be defined as a "process where a man in a dependent position is helped in such a way that he acquires power," also noting that it is necessary that the people being empowered have "the will" to change – otherwise they may become further marginalized from society. Patient empowerment became widely known when it was used by Bill Clinton during his 1992 presidential campaign under its initial name of Health Security Express. In fact, one of its developers, Professor Roderick MacFarquhar of Harvard University, was present on the platform with Clinton when he announced his idea and vision for a health care program. Patient empowerment is used in several different ways: By using patient education to empower people to take control of their lives, doctors can help patients achieve better health outcomes and reduce costs over time. A 2012 systematic review found strong evidence that educational interventions are effective at increasing patients' knowledge about cancer prevention practices with moderate evidence that these interventions are also beneficial for changing behavior. Another review published in 2009 found that patient education empowers people by helping them gain more control over how they manage their disease or condition. The authors noted, however, that there were gaps in the research regarding how best to help people manage self-care and that an important next step would be to conduct more research into this area. Some of the tools used by patients for empowerment include: Patient empowerment is said to occur when health care providers communicate with patients about their condition, treatment options, the expected results of the treatment plans, possible risks involved, and patient's desires. The goal of empowerment is for patients to make informed decisions about their own health care plan. These health care plans are based on shared decision making between the doctor and patient wherein both parties cooperate toward a single goal – optimal public wellness. Physicians are now less likely to use paternalism within their practice because empowering patients has been linked to improved clinical outcomes. This means that if the patient is not empowered, then they cannot get the desired results from a particular treatment plan and this leads to unnecessary costs in medical care. In order for patients to be able to make good decisions about their health, they need to have general knowledge of their condition or illness. For example, someone with arthritis will have an easier time making good choices about how to control their pain when they understand what causes it and what treatments are available. If the patient is given more information on which treatment options may produce better outcomes (such as lower risk of adverse reactions), then they can make educated choices between different forms of therapy (drug therapies versus surgical procedures). However, if the patient does not understand why one type of therapy would be better than the other, the treatment outcomes will be suboptimal. The extent of patient empowerment is largely dictated by the level of patient education prior to visiting the doctor's office. The concept of patient empowerment follows two interconnected principles: (1) people are more empowered when they have knowledge; and (2) people with knowledge make good decisions about their health care. If patients lack knowledge, they may not be able to make informed choices about self-care or comply with a treatment plan that could lead to improved wellness. For example, patients who do not understand how diabetes affects them or why they should monitor their blood sugar levels may not be as proactive about managing their illness as those who do have this information. In this case, both knowledge and empowerment are closely related. In fact, a study published in the Journal of Public Health found that patient empowerment helped patients lose weight more effectively than providing direct personal counseling on obesity-related issues (such as calorie intake or exercise). While other factors could have contributed to this result, one reason why the intervention worked well may be because it increased patient knowledge about how to reduce their risk of certain conditions linked to obesity. The idea of education is also important within the doctor-patient relationship. A doctor who provides information about treatment options can empower patients by giving them greater control over their health care decisions, which results in higher quality wellness outcomes due to better informed choices. For example, if an older adult with arthritis has the opportunity to learn about their condition and how it will progress overtime, they may make better decisions about joint replacement surgery in the future. When patients can make informed choices about their health care plan, they are more likely to follow through with treatment, which leads to better outcomes. This is true for both preventative treatments (such as cancer screenings) and treatments that restore health after an illness develops (such as chemotherapy after breast cancer). The World Health Organization's Commission on Social Determinants of Health has ranked empowerment among people toward highly effective solutions to social problems such as poverty or access to affordable healthcare. According to the commission, "progress requires collective action by national governments acting within international agreements". These agreements include economic policies geared toward fighting poverty at home and abroad. The commission has called for global policy changes in how economic development, public health management, labour issues and education are handled. The commission's call was echoed by the 2010 Pulitzer Prize-winning author ("The Spirit Catches You and You Fall Down"), who wrote that community empowerment is essential to curing major social ailments like poverty or even global conflicts. "I believe that when you empower people, they will act responsibly," she wrote, "and that when they act responsibly, solutions follow." Jilek also urged the need for further research into what makes certain efforts at empowering people successful while others fail. She concluded her article with a quote from her co-author on "The Spirit Catches You", Anne Fadiman: “When I ask myself what has made the biggest difference in my own life, I always come back to the same answer: other people.” Many medical education programs are beginning to focus on patient empowerment as well. Some evidence-based curricula aim to improve public health knowledge and self-care skills by involving patients actively in their healthcare decisions. Programs like these could help ensure that increasing numbers of patients make informed choices about how to manage their chronic conditions or protect themselves from illness through vaccinations or lifestyle changes (e.g., nutrition). Programs focused on empowering populations with resources for behavior change may be beneficial for improving overall wellness among high risk groups for certain diseases. A study published in the New England Journal of Medicine found that an intervention developed by researchers at Massachusetts General Hospital and Harvard Medical School to increase physical activity among Boston Marathon runners was effective. The intervention included personalized text messages sent on a daily basis as cues to encourage participants to meet their exercise goals for the day; those who received more overall encouragement were more likely to be physically active. When participants received feedback on their results, they felt better about their ability to change their lifestyle habits by exercising more often. This study's findings suggest that digital health interventions focused on empowering patient populations with specific skills might be promising in changing behaviors for chronic disease management—specifically, improved wellness outcomes from increased physical activity. In 2014, President Obama announced a "Patient-Centered Outcomes Research Institute" (PCORI) that aims to ensure that patient preferences are considered in all research conducted throughout the nation's healthcare system. PCORI was formed as an independent non-profit organization that aims to provide patients with the information they need to make more informed decisions, support research that can directly improve patient care, and help doctors and other health providers make well-informed treatment choices for their patients. Patient education is a method of communication between medical professionals and patients about biomedical information. It encompasses the process of informing patients about disease processes, diagnostic tests, treatments, preventive measures, or self care options. The goal of patient education is empowerment: empowering the individual by providing knowledge and tools to facilitate informed decision making; empowering communities by increasing public awareness; and empowering organizations like hospitals by improving quality of care within their institutions. Patient education is used in many settings; it can happen between a physician and patient, or among a group of patients who have been diagnosed with similar illnesses or conditions. It may occur during medical visits, community health outreach programs, conferences, or other places where people gather to learn about a specific condition. Some educational initiatives are designed for the general public so that individuals without a specific disease diagnosis receive information about how to prevent future illness or injury. In all populations, including those at-risk for disease development as well as those without risk factors knowledge of ways to increase wellness is important for optimal quality of life. In its broadest sense, patient education occurs any time someone learns from someone else: parents teach children, teachers teach students, friends share information with each other. Health-related patient education is the process of sharing knowledge about health and disease that encourages people to assume responsibility for their own health status. The following are learning theories that have been utilized in various aspects of patient education: behavior modification, cognitive development, constructivism, guided participation, kinesiology (the study of human movement), learning principles/styles examination, perceptual control theory (PCT), psychoanalysis, social learning theory (SLT), systems theory/cybernetics. Some of these theoretical approaches are incorporated into medical school curricula or training programs for educators to become more effective educators who can deliver the best possible instruction to patients. Other theories are used by organizations to design their educational initiatives. Most health professionals have training in biological sciences as well as education and communication skills. They also have content knowledge related to the disease processes or treatment regimens that they are expected to teach their patients. These qualifications give them a fundamental understanding of patient education theories and principles needed for effective teaching. In addition, educators with many years of clinical experience and advanced specialty training may possess advanced knowledge about diseases and how to treat them, which can make them even more effective educators. On the other hand, it is difficult for physicians to keep up with all of the latest scientific evidence regarding new therapies, targeted drug therapies, dietary changes, and lifestyle modifications because such information is rapidly evolving (and is quite costly). For this reason, most physicians consult with their colleagues to stay informed about what types of patient education may be most beneficial for different populations of patients. Physicians must also find ways to keep abreast of new advances that will affect the care they provide to their patients. The following is a review of several patient education topics, along with a section on how selected learning theories may apply to each topic. The list is not exhaustive; it represents only some examples from a vast array of topics related to health promotion and disease prevention. For more information about these clinical conditions or treatment regimens, click on their links for additional resources. Aspirin therapy has been shown in studies to reduce the risk of cardiovascular events such as myocardial infarction (heart attack) and ischemic stroke in people with known coronary artery disease, peripheral arterial disease (PAD), or cerebrovascular disease. A systematic review of randomized controlled trials (RCTs) about the clinical benefits of aspirin therapy in various patient populations verified that aspirin therapy reduced cardiovascular events; however, there was no clear evidence of whether aspirin reduced the risk for all-cause mortality, nonfatal myocardial infarction (heart attack), heart failure, or revascularization procedures. The authors also noted that RCTs evaluating aspirin therapy did not provide enough information to determine which groups may be at increased risk for harm from aspirin use. In addition, observational studies have reported an increase in gastrointestinal hemorrhage from low-dose aspirin therapy in patients with a history of peptic ulcer disease (PUD). The USPSTF and CDC recommend that clinicians should regularly update their patient education about aspirin use to provide information about risks and benefits based on new scientific evidence. The recommendations also suggest including information about aspirin use by age groups, such as older adults. In addition, it is recommended that clinical decision-making support tools (e.g., online calculators or guidelines) should be used to assist providers with prescribing decisions. Constructivist theory may apply to teaching patients about the personal risk factors for cardiovascular disease, whether they are at higher risk because of hypertension, diabetes mellitus, hyperlipidemia (high cholesterol), obesity/sedentary lifestyle, or smoking. This theory emphasizes that learning is a function of the assimilation of knowledge based on pre-existing cognitive structures, which are influenced by prior experiences and social contexts. In other words, individuals construct their own knowledge base from information they have obtained from their environment. Constructivist teaching methods for patient education about cardiovascular disease prevention may include asking open-ended questions about how patients feel when they learn new information to help them process the topic in a manner that fosters understanding and enhances motivation to change health behaviors. Constructivist theory also suggests that people actively seek out health information and incorporate it into what they already know or believe. Thus, this type of patient education may be more effective if its content matches individual patients' needs and concerns related to cardiovascular disease prevention. The Transcendental-Humanistic theory, which is based on the work of Carl Rogers and Abraham Maslow, may also prove useful when patient education about aspirin therapy is provided. This theory espouses that to be effective in helping patients learn about their health or make changes in their lifestyle to address a health concern, clinicians must understand the patient's concerns and develop an empathic relationship with them so they can provide support when needed. For example, to help patients who are at increased risk for cardiovascular events due to hypertension or diabetes mellitus, but lack motivation or skill to manage these disorders through lifestyle modifications (e.g., dietary changes), it may be helpful for clinicians to offer encouragement to help overcome obstacles created by these conditions. The Transcendental-Humanistic theory also suggests that clinicians should engage patients in health practices (e.g., patient education) by eliciting their participation and providing them with choices, rather than simply dictating practice options or what patients "should do." Based on the patient educational needs assessment results shown below, the following information may be provided to tailor patient education about aspirin efficacy and safety: This type of individualized intervention may serve as a model for future approaches to tailoring patient education about aspirin therapy to the broader population of adults age 50 years or older who are at increased risk for cardiovascular disease. However, more research is needed to determine whether tailoring aspirin information will benefit either patients' understanding of this medication or their willingness to use it. Patient education is an important aspect of patient care because providing patients with information about their disease or condition (e.g., prevention strategies, medications) not only helps them understand their health concerns but also makes them better partners in their own care by enabling them to actively participate in decisions about how best to manage these conditions. Patient education has the potential to influence multiple patient outcomes, such as reducing risk behaviors that lead to disease (e.g., smoking cessation); improving adherence with medical therapy; enhancing self-management skills; and promoting quality of life, health behavior change, and reduced anxiety levels. Many forms of patient education exist , including formal education provided by clinicians or other healthcare professionals during office visits or educational sessions held in other healthcare settings (e.g., hospitals, community clinics); independent patient education materials that patients or their caregivers can review on their own; and peer-to-peer health counseling services designed to help individuals manage their health. Patient education can be offered in various formats, including printed materials (e.g., brochures, pamphlets), audiovisual presentations (e.g., television programs, computer software), and electronic media (e.g., CDs). Finally, this intervention may occur in a variety of healthcare settings, including physicians' offices; outpatient clinics; hospitals; long-term care facilities (e.g., nursing homes); worksites; pharmacies; public health departments; schools; senior centers; other community locations (e.g., malls); and homes of patients or their caregivers. Specific patient education is a type of tailored patient education that is used to help individuals better understand medical information and make informed choices about health care management . It has the advantage of focusing on information that is most relevant, interesting, and important to patients (e.g., patient-centered learning). Patients who receive specific advice from providers about how to prevent disease or manage existing conditions are more likely to take positive steps toward improving their health status than those who receive general advice (e.g., "Eat right and exercise"). Background: Aspirin use can be divided into three periods: nonuse, unsafe use, and proper use. Many people have misconceptions regarding aspirin's safety, efficacy, and appropriate use. The following information may be provided to tailor patient education about aspirin efficacy and safety: This type of individualized intervention may serve as a model for future approaches to tailoring patient education about aspirin therapy to the broader population of adults age 50 years or older who are at increased risk for cardiovascular disease. However, more research is needed to determine whether tailoring aspirin information will benefit either patients' understanding of this medication or their willingness to use it. Patient education is an important aspect of patient care because providing patients with information about their disease or condition (e.g., prevention strategies, medications) not only helps them understand their health concerns but also makes them better partners in their own care by enabling them to actively participate in decisions about how best to manage these conditions. Patient education has the potential to influence multiple patient outcomes, such as reducing risk behaviors that lead to disease (e.g., smoking cessation); improving adherence with medical therapy; enhancing self-management skills; and promoting quality of life, health behavior change, and reduced anxiety levels. Many forms of patient education exist, including formal education provided by clinicians or other healthcare professionals during office visits or educational sessions held in other healthcare settings (e.g., hospitals, community clinics); independent patient education materials that patients or their caregivers can review on their own; and peer-to-peer health counseling services designed to help individuals manage their health. Patient education can be offered in various formats, including printed materials (e.g., brochures, pamphlets), audiovisual presentations (e.g., television programs, computer software), and electronic media (e.g., CDs). Finally, this intervention may occur in a variety of healthcare settings, including physicians' offices; outpatient clinics; hospitals; long-term care facilities (e.g., nursing homes); worksites; pharmacies; public health departments; schools; senior centers; other community locations (e.g., malls); and homes of patients or their caregivers. The following types of patient education are not meant to be exhaustive but rather illustrative: Specific patient education is a type of tailored patient education that is used to individuals better understand medical information and make informed choices about health care management . It has the advantage of focusing on information that is most relevant, interesting, and important to patients (e.g., patient-centered learning). Patients who receive specific advice from providers about how to prevent disease or manage existing conditions are more likely to take positive steps toward improving their health status than those who receive general advice (e.g., "Eat right and exercise"). This type of individualized intervention may serve as a model for future approaches to tailoring patient education about aspirin therapy to the broader population of adults age 50 years or older who are at increased risk for cardiovascular disease. However, more research is needed to determine whether tailoring aspirin information will benefit either patients' understanding of this medication or their willingness to use it. A broad range of educational methods can be used for patient education, including didactic learning (e.g., lectures), experiential learning (e.g., group discussion, hands-on practice), and self-management activities or skills training . Didactic learning generally refers to a technique in which an individual is provided with information in a lecture format. Experiential learning typically involves talking through coping strategies and/or practicing them within the context of a role play or other types of simulation exercise. Self-management activities include techniques that focus on building interpersonal skills such as communication and problem solving, enhancing self-efficacy by teaching patients how to successfully manage their chronic conditions, promoting skills such as goal setting and self-monitoring, and providing practice in the application of skills. Other examples of techniques for patient education include use of audiovisual materials (e.g., films), computer technology (e.g., Internet resources and CD-ROMs), and so-called "motivational interviewing" approaches to help motivate patients to adopt healthful behaviors. The type of educational method used is likely to depend on the audience, available resources, perceived barriers or preferences toward learning styles, amount of time allocated for an intervention session(s) with a patient, and the patient's prior experience with that specific type of educational method . For example, patients who are older may prefer more didactic methods or group sessions because they find it difficult to assimilate information presented in an experiential format. Patients with chronic conditions who receive more intensive treatment (e.g., frequent face-to-face contact) that includes increased use of patient education are more likely to comply with their treatments than those who receive less intense interventions . Other studies suggest that, even if educational intensity is the same, patients have better outcomes when they are actively involved in treatment decisions rather than being "passive recipients" of care . Patient involvement typically has been operationalized as staying informed about one's medical condition or treatment choices, taking positive steps toward disease management, and/or exerting control over healthcare decision making through active participation in care planning processes. Thus far, most available evidence suggests that patient education can help patients with chronic conditions gain greater control over and stronger commitment to their disease management. However, the role of patient involvement is not fully understood and requires more research. Patient expectations form the foundation for how they react to any situation within healthcare . Patients who feel that they lack control or influence over decisions concerning their treatment or care may experience feelings such as vulnerability, passivity, and overwhelming anxiety about medical decision making . Thus far, researchers have identified two types of roles individuals play when receiving health care: a "compliance" role (e.g., be informed, ask questions) and a "participation" role (e.g., understand what's going on, make choices). The literature suggests that patients are more likely to assume a compliance role when they feel their safety is threatened, whereas patients are more likely to assume a participation role when they feel an emotional bond with their providers . Unfortunately, the effect of patient education may depend on what type of role individuals apply in situations involving health care. The benefits of patient education are thought to outweigh the risks of participating in activities that provide information and help facilitate coping with chronic diseases. Patient education can also help improve communication between provider and patient, which can result in better healthcare teamwork . For example, shared decision making has been shown to decrease anxiety among patients by giving them appropriate control over treatment decisions without compromising quality of care. Some studies have even found that when using shared decision-making strategies, patient education resulted in fewer hospitalizations and physician visits . Researchers have found that patients who receive more information about their illness or treatment tend to feel better prepared for what will happen, which decreases the stress experienced during a medical episode . Although communication skills are central to good physician-patient interactions, there is evidence to suggest that many physicians may lack appropriate communication skills when talking with patients . A review of studies on clinical communication found that both patient and physician characteristics (e.g., age, gender) affect how well they communicate with each other during any given medical encounter. Moreover, because communication occurs along a continuum from nonverbal cues (e.g., vocal tone) to verbal content (e.g., words used), effective communication is likely to be influenced by a combination of these factors . Patient education can help patients cope with chronic diseases and prepare for future events. However, since patient education aims to improve the healthcare experience, it should not compromise either safety or quality of care. The following seems like good advice: "patient education needs must be balanced against the potential risks and benefits—for both patients and providers—in order to optimize outcomes ." More research is needed before researchers fully understand how patient education affects those participating in medical situations. Insurance Prior Authorization Services, Patients Access and Medical Documentation Reviews and Audits. In this time of economic downturn, one area that hospitals and medical practices need to work on is their patients' satisfaction. The internet has made it easier for people to communicate with each other and share information about a company or service. When a patient gets a satisfactory experience from a doctor's office or hospital, they are more likely to tell others about the good experience. On the opposite side of the spectrum, when someone has been dissatisfied with their service from a business or medical practice, then they are much more willing to express that fact all over social media sites such as Facebook and Twitter. In this article I will discuss ways in which satisfaction levels can be improved by offering better customer service through various methods including: hiring warm staff members who genuinely care about their patients, ensuring a clean environment, and having a clear understanding of patient expectations.
The first step to improving the satisfaction levels for your medical practice or hospital is to hire staff members who genuinely care about their patients. A study done by Danette Howard at Florida State University revealed that nurses with positive personalities are more likely to improve patient satisfaction than those showing negative attitudes . It shows that staff members who treat every person they meet as an individual are better suited for providing customer service than someone exhibiting negative behavior. Another survey done by All-About-Vision.com found that over 60% of people do not like dealing with eyeglass salespeople because they act pushy and give "attitude" . The same can be said for doctors and medical staff members in a hospital. When patients walk into a room or to an appointment, they become nervous about what is going to happen and whether someone will be kind enough to help them understand their options. In addition, employees should have clean appearances when they are making rounds or meeting with patients. If a patient walks into an office and the staff members look disheveled and exhausted, then the initial impression may not set up for a positive experience during their visit. A study conducted by Ann Marie Fiore from West Virginia University showed that hospital visitors found people in sterile uniforms more trustworthy than those wearing casual attire . In other words, if your staff members wear scrubs or lab coats when they meet with patients, then patients will feel that they are being treated with greater care and attention. Hiring staff members who are warm, caring individuals along with employees that have a positive appearance will help improve the satisfaction levels for your medical practice or hospital. The next aspect of customer service to consider is how clean your facility is kept. People want to go into an office or room knowing it will be perfectly neat and orderly . If there are papers scattered on desks, trash on the floor, stains on the chairs, and other elements that make the room look unclean then patients are not going to feel comfortable during their appointment or stay in that room. Let's think back to when you were in school as a child : wouldn't you want your classroom to look perfect before having visitors come inside? The same idea applies when people are in a doctor's office or hospital room. Another element to consider is the patient expectation factor. In other words, you need to have an outline of what the patient expects from your staff members and how their time will be spent while they are visiting with your company . If there is no clear understanding about what type of service a person can expect, then it will create tension between both parties resulting in negative feelings about the entire experience. For example, Dr. Goodson from Yankton Animal Clinic in South Dakota states that " When clients come for a wellness exam or appointment, we don't have any veterinary business assistants working here yet, so I do all the check-in myself right away" (Bauer). If you are reading this article in the doctor's office waiting room, then you can see how important it is to have a desk set up with someone who is ready and able to discuss any questions or concerns that will come up. On the other hand, if a patient walks into an office and there is no one available to help them, they may feel as though their time was wasted by just sitting down and waiting . In order for medical practices and hospitals to increase satisfaction among their customers, they need to hire staff members who will create a clean environment and understand what patients expect from their visits. The final step of improving the customer service experience is making sure that your staff members follow through on everything they say. When working at a hospital or medical office, sometimes people are panicked or can become confused very easily. Your job is to make sure that your staff members are able to take control of the situation so patients feel safe and comfortable at all times . For example, if a patient comes in for surgery, then they want to know exactly what is going to happen so there are no surprises later on. If you have an employee who has worked at your hospital or practice for several years , ask them if they remember any questions that were brought up when people were preparing for surgery. This way you know whether employees have been listening properly during conversations with patients and trying their best to answer everyone's questions thoroughly . Another tip that may be helpful is saying "I will do my best to find out the answer to your question and get back to you soon." This shows that your staff member is willing to help in any way possible while at the same time giving them a deadline for when they will respond . The last thing we need to do in order to improve customer service satisfaction is constantly observing your employees and making sure they are following through with their actions. If you see an employee constantly having issues with this, then make sure you sit down and talk about it with them directly.  NO SURPRISES ACT IMPLEMENTATION: WHAT TO EXPECT IN 2022 As a result of the 2021 Consolidated Appropriations Act, several No Surprises Billing Act regulations will go into effect on Jan. 1, 2022 for providers, facilities and air ambulance services. The No Surprises Billing Act regulations came into play to protect patients from surprise medical bills. These regulations will affect providers, facilities, and air ambulance services that receive payment from a commercial insurer for providing emergency or non-emergency care to a beneficiary in a health care emergency situation. Providers must comply with the regulations if they want to continue working under these insurance plans. Providers, facilities, and air ambulance operators can avoid falling out of compliance by getting their billing processes ready before Jan. 1, 2022. Here is what you need to know about the 2021 Consolidated Appropriations Act: What are "No Surprises" claims? The term "No Surprises Billing" has been around for more than 20 years, but the full act was passed in 2021. This act requires providers to disclose medical billing information to patients prior to rendering services if they receive payment from commercial insurers for providing emergency or non-emergency care. Providers must inform patients about out-of-pocket costs and may not balance bill them for covered charges after receiving payment from insurance companies. Covered entities include: Health care providers (physicians, hospitals, imaging centers, therapists) Laboratories Air ambulance services (ground or air) What types of claims are affected by the Act? The regulations affect all "No Surprises" claims—including claims for emergency medical care, inpatient hospital admission, and outpatient treatments. However, non-covered medical expenses like cosmetic surgery or dental work are not affected by the regulations. What is considered an "emergency" under the regulations? The regulations protect patients receiving emergency medical care, including surgeries and treatment for acute episodes of illness/injury which pose a threat to life or limb. Emergency medical care may also include transportation to the hospital if it is recommended by EMTs. Patients will be protected from any out-of-network charges exceeding $1,000 incurred during actual emergency services only (to include EMS services). It does not apply to non-covered services like cosmetic surgery or dental work. What billing statements need to be sent before Jan. 1, 2022? Providers can avoid falling out of compliance by sending one of three disclosures prior to rendering services: An advance written notice that informs patients of potential out-of-pocket costs and discloses all the providers who will participate in their care. The notice must include a list of all other providers involved in patient's care, an estimated dollar amount for each non-covered service and the dollar amount the patient will be responsible to pay for each provider. Providers can describe these amounts as "your estimated responsibility" if they don't have exact figures at the time of the disclosure, but it must include a disclaimer statement if no actual estimate is available. A separate written notice informing patients that they may be liable for more than $1,000 if insurance does not cover any or part of their medical bill that needs to be provided before services are rendered. The patient cannot be billed until the total cost has been disclosed to them. Providers must inform patients of their right to refuse services if they anticipate an out-of-network provider will be involved in care and that a bill may result from non-covered providers. In this case, the patient is no longer protected under the No Surprises Act for any charges incurred above $1,000 as a result of non-covered services from those providers. Patients must also receive a final written estimate from every participating provider before being transferred or discharged from a facility/hospital to have "reasonable assurance" all fees have been disclosed prior to rendering services, according to CMS guidelines . What can happen if you don't comply with these regulations? State agencies overseeing licensure can assess penalties of $1,000 for the first offense and up to $10,000 per subsequent infraction. Civil money penalties of $5,000 or up to $50,000 per incident may be assessed against individual physicians and other practitioners who violate the patient disclosure requirements. Physicians found to abuse their patients rights under this Act could face disciplinary action from state medical boards. What's the bottom line? CMS estimates that 56 million consumers receive surprise medical bills each year. The No Surprises Act is intended to ease some of these financial burdens by requiring all providers—including hospitals and out-of-network doctors—to provide upfront billing information about potential charges so patients aren't in a position where they must make difficult choices between paying for lifesaving treatments or putting food on the table. The No Surprises Act was signed into law in December 2016 and takes effect January 1, 2022. These regulations ease some of the burden that surprise medical bills place on patients when they receive care from non-contracted providers like ER doctors or specialists who don't accept insurance—even when the services are viewed as emergencies by insurers. Under these new regulations, patients will be protected under what's known as "surprise billing" protections for covered medical expenses like emergency procedures performed at in-network hospitals or ambulances operated by contracted transportation companies. The No Surprises Act also requires that physicians disclose all participating providers before rendering any service in an effort to allow patients to make informed decisions about their clinical needs or insurance coverage. At this time, CMS does not consider CT scans to fall under these regulations unless performed in an emergency. No surprise it's a tough time to be working in health care... CMS Issues Proposed Rule for No-Surprises Billing Protections -- While many of the changes are good news, other aspects are frustrating both providers and patients. Patients will be protected under what's known as "surprise billing" protections for covered medical expenses like emergency procedures performed at in-network hospitals or ambulances operated by contracted transportation companies. The No Surprises Act also requires that physicians disclose all participating providers before rendering any service in an effort to allow patients to make informed decisions about their clinical needs or insurance coverage. At this time, CMS does not consider CT scans to fall under these regulations unless performed in an emergency. CMS Issues Proposed Rule for No-Surprises Billing Protections -- While many of the changes are good news, other aspects are frustrating both providers and patients. Under these new regulations, patients will be protected under what's known as "surprise billing" protections for covered medical expenses like emergency procedures performed at in-network hospitals or ambulances operated by contracted transportation companies. The No Surprises Act also requires that physicians disclose all participating providers before rendering any service in an effort to allow patients to make informed decisions about their clinical needs or insurance coverage. At this time, CMS does not consider CT scans to fall under these regulations unless performed in an emergency." And to make it even better, the "No Surprises" Act takes effect January 1st... Although not entirely unexpected (the No Surprises Billing Act was part of the 2016 Consolidated Appropriations Act), CMS has proposed regulations that go into effect Jan. 1, 2022 that provide protections for insured patients who receive care from out-of-network physicians and other providers involved in surprise billing practices. The American College of Emergency Physicians (ACEP) issued a statement saying it is pleased with these rules as they recognize emergency care as necessary medical care requiring treatment by any physician willing to render such service. ACEP also said it continues to review specific provisions within CMS's proposed rule and will submit detailed comments pointing out language that needs clarification or revising. CMS has proposed that physicians and hospitals must: - provide written notice to patients of the right to receive emergency services from an out-of-network provider without balance billing, and must disclose all providers within the same hospital system who will be involved in a patient's care; - if they do not have direct access to this information, inform them of their right to receive such written notice directly from any physician or other health care provider rendering such services as long as such notice is provided before receiving medical treatment; and - make reasonable efforts to arrange emergency services with an out-of-network provider who will agree, prior to providing such service, either: (i) accept the insurer's negotiated rate as payment in full for such emergency services; or (ii) to bill the patient for any balance above the insurer's payment. The American College of Emergency Physicians (ACEP) issued a statement saying it is pleased with these rules as they recognize emergency care as necessary medical care requiring treatment by any physician willing to render such service. ACEP also said it continues to review specific provisions within CMS's proposed rule and will submit detailed comments pointing out language that needs clarification or revising. CMS Issues Proposed Rule for No-Surprises Billing Protections -- While many of the changes are good news, other aspects are frustrating both providers and patients.  FREE WEBINAR: NO SURPRISES ACT FOR PROVIDERS AND SURGERY CENTERS FREE WEBINAR: NO SURPRISES ACT FOR PROVIDERS AND SURGERY CENTERS Ms. Campanella is a nationally respected Healthcare Attorney who dedicates herself to educating professionals on issues of business transactions and regulatory compliance. She focuses her practice on business law, health care regulatory and transactional matters, and residential and commercial real estate. She has extensive experience assisting clients with transactional services and regulatory compliance consulting and has provided general counsel services to small and large businesses, medical practices, professional societies and real estate clients alike. Certifications HIPAA Academy Certified HIPAA Administrator Fellow, American College of Healthcare Executives This Webinar will provide you more clarity about the topic on "No Surprises Act". The No Surprises Act protects patients covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities. Since it took effect on January 1, 2022, we have been getting so many calls from our clients and other source referrals asking how they can comply with this new rule. And how the "No Surprises Act" impacts medical practice offices and ASC Ambulatory Surgery Centers settings. In this Free Webinar, our speaker who is a Healthcare Attorney will thoroughly explain the most important topics related to this new rule: (1) Understanding the "No Surprises Act"; (2) Why Billing at of out-of-network rates can be difficult and what you need to do to stay compliant with the new rule; (3) How providers are required to give the patients a "good faith estimates" of the cost of the services provided to uninsured and self-pay patients in advance or prior to the patient's appointment; (4) No "balance-billing" allowed for out-of-network emergency care until the patient gave consent and safely moved to an in-network facility; (5) No "balance-billing" allowed for patients that are on-scheduled out-of-network services when the facility is considered as in-network facility unless the patient has been notified and provided consent; (6) How your office and your surgery center can comply with this new rule by implementing a new operational workflow and proper training of your staff; (7) How your patients will have the best patients’ experience. This Webinar will surely answer so many of your questions and uncertainties. The truth is, we have no choice, it is here now! And it took effect on January 1, 2022. And we have to comply with this new rule. We have to implement this in our practice offices and in ambulatory surgery centers. Ms Gina Campanelli is a Healthcare Attorney, there is no better person to help us understand and comply this new rule. See you all (virtually) to our upcoming webinar! Remember this is FREE, seats are limited! So REGISTER TODAY! Question about this Event? Call us (the Organizer) at (800) 267-8752 or visit us online at www.gohealthcarellc.com and drop us a line!  BILLING USING GLOBAL SURGERY MODIFIERS 24, 25, 54, 55, 57, 58, 78, 79 These are Modifiers you use during Post-Surgery!How to use the Global Surgery Modifier 24 Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period: The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the modifier 24 to the appropriate level of E/M service. How to use the Global Surgery Modifier 25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service: It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or be beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. Note: This modifier is not used to report an E/M service that resulted in a decision to perform major surgery. See modifier 57. For significant, separately identifiable non-E/M services, see modifier 59. The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. How to use the Global Surgery Modifier 54 Surgical Care Only: When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding the modifier 54 to the usual procedure code. Services billed with a 54 modifier will be reimbursed at the intraoperative allowance for the surgical procedure. The intraoperative allowance includes the one day preoperative care, the intraoperative service, as well as any in-hospital visits that are performed. How to use the Global Surgery Modifier 55 Postoperative Management Only: When one physician performs the postoperative management and another physician has performed the surgical procedure, the postoperative component may be identified by adding the modifier 55 to the usual procedure number. How to use the Global Surgery Modifier 57 Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service. How to use the Global Surgery Modifier 58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: It may be necessary to indicate that the performance of a procedure or service during the postoperative period was (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding the modifier 58 to the staged or related procedure. Note: For treatment of a problem that required a return to the operating or procedure room (e.g., unanticipated clinical condition), see modifier 78 (below) How to use the Global Surgery Modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first and requires the use of an operating room, it may be reported by adding modifier 78 to the related procedure. (For repeat procedures, see modifier 76). How to use the Global Surgery Modifier 79 Unrelated Procedure by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using the modifier 79. (For repeat procedures on the same day, see modifier 76). When one physician performs the postoperative management and another physician has performed the surgical procedure, the postoperative component may be identified by adding the modifier 55 to the usual procedure number.  AMERICAN ACADEMY OF PAIN MEDICINE 38TH ANNUAL MEETING will be held in Scottsdale, AZ !  Image Source: www.aapmannualmeeting.com This year's theme is Today and Tomorrow in Pain Medicine: Innovations and Practical Applications. 
Image Source: www.aapmannualmeeting.com
 Image Source: www.aapmannualmeeting.com Check out their website for more information on Registration, the Venue and Sponsorship at AAPM American Academy of Pain Medicine 38th Annual Meeting 2022. CLICK HERE.  As a company, we have grown and been around in the medical industry for nearly 22 years. And 98% of our clients are Pain Physicians, focusing in Interventional Pain Management Procedures. (Anesthesiologists, Neurologists and Physiatrists). We are mostly hired for Utilization Management, Medical Coding and as Compliance, Documentation & Reimbursement Audit Consultants. It is very common that most pain physicians' dilemma are why there is always a struggle in their claims getting paid appropriately (worse getting denied for non-payment) and their prior authorization are always being denied for non-medical necessity. They are trying to understand the why(s)? See, as a Medical Practice Healthcare Consultant myself, I have always advised Providers, they must understand clinical and reimbursement guidelines. And in this blog I am going to share with you reading resource called "Safety Practices for Interventional Pain Procedures" so you can relate on every insurance payers out there including Medicare with their Clinical, Billing and Reimbursement guidelines. All the PDF reading & learning materials here are owned by SPINE INTERVENTION SOCIETY.  source: The Lancet I truly find these materials (SAFETY PRACTICES FOR INTERVENTIONAL PAIN PROCEDURES) very useful when we are working on utilization management cases. We are not physicians, most of us are non-practicing nurses but it is very critical for us that we do understand what our Pain Physicians performing in terms of their procedures. Our team are using these materials for more understanding of these procedures and I always share it to all my Pain Physicians clients. I also recommend to them to check  Happiest when no more pain. SAFETY PRACTICES FOR INTERVENTIONAL PAIN PROCEDURES PDF files are shown below downloaded from Spine Intervention Society public domain. You can visit their organization today!
If you are a Medical Practice, Facility or a Pain Physician struggling in getting your procedures approved for Prior Authorization, contact us today! We have 98% approval rate every time we pursue the case! We can make you very, very busy with your procedures! Or if your reimbursement is slow and not appropriate or worse not getting paid at all, you might have issues with your coding and billing. Contact us, we can guarantee you we can help either you are Out of Network or In-Network. We can also help you with injury cases (Motor Vehicle Accidents & Workers Compensation). ASC or Ambulatory Surgical Center billing and coding? we got that covered for you too! So smile! contact us TODAY! Don't take our word for it.... READ REAL TESTIMONIALS HERE Yes! we were there as one of its Sponsors at the New York & New Jersey Pain Medicine Symposium 2021!    With the Famous Dr. Gabriel Jasper from New Jersey! I adore this Spine Doc! He is amazing! 
Are the above questions also common to you and you don't know what's the best answer for these questions? We had a great time meeting with all our current Pain Practice clients and providers and have met several more potential clients that we can mostly provide value!  I was invited again to speak at the Obesity Medicine Association on Medical Billing and Coding for Obesity Medicine Services. That moment after your presentation at a Medical Event ... the flash of lights is simply amazing when you know you have brought in so much value and you commit yourself to continue becoming more and working more so you can serve more! I am always grateful for the speaking opportunity! Thank you for having me as an invited Speaker! OMA Obesity Medicine Association #OMA2021 From my Facebook Post: "I am honored to be invited to speak at the Obesity Medicine Fall Event again! This time will be at the Grand Sheraton in Chicago! It’s good to be back, the last time I was invited to speak here was in 2018 in Seattle, Washington State. This is a very good exposure for my company with approximately 600 Physicians in my audience plus an hour of Q&A plus another breakfast session will be amazing! I am very excited for the opportunity! https://obesitymedicine.org/fall/plan/" #obesitymedicine #obesitymedicinefallevent2021 In my Tweet: Finally on the OMA App .. I will be speaking at the Obesity Medicine Association on September 24, 2021 at the Sheraton Grand Chicago Hotel! It’s good to be back at this event as an Invited Speaker! #obesitymedicine #speaker #leadership  Effective November 1, 2021 United Healthcare will require you to request Prior Authorization for the following services for Interventional Pain Management. This is effective November 1, 2021.  Notice that mostly are for your Cervical & Thoracic regions. Notice that it is also required for your Genicular Nerve Block (but NOT for the Genicular Nerve RFA) and SI (but for the RFA). Codes that require Prior Authorization from UHC:United Healthcare Pain Management Injection Requiring Prior Authorization Effective November 1, 2021  United Healthcare Pain Management Injection Requiring Prior Authorization Effective November 1, 2021 CPT Code Description 62292 INJECTION PX CHEMONUCLEOLYSIS 1/MLT LUMBAR 64620 DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE G0260 INJ PROC SI JNT;ANES STEROID&TX AGT&ARTHROGRPH 62320 NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN 62322 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN 62324 NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN 62325 NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN 62326 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN 62327 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN 62350 IMPLANT SPINAL CANAL CATHETER 62351 IMPLANT SPINAL CANAL CATHETER 62360 INSERT SPINE INFUSION DEVICE 62361 IMPLTJ/RPLCMT FS NON-PRGRBL PUMP 64451 INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG 64454 INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG 64480 NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL 64484 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL 64491 NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL 64492 NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL 64494 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL 64495 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL 64520 INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC 64634 DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA 64636 DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL 64640 DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE Read more about this update here: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/network-bulletin/pain-inject-management-nb-appendix-auwww.uhcprovider.com/content/dam/provider/docs/public/resources/network-bulletin/pain-inject-management-nb-appendix-august-2021.pdfgust-2021.pdf Today is October 8, 2021. Have you not noticed your claims are being rejected by your practice management clearinghouse as "Invalid ICD-10 Code"?  ICD-10 M54.5 DELETED EFFECTIVE OCTOBER 1, 2021 ICD-10 Pain Management Code M54.5 Deleted Effective October 1, 2021! Yes?! Well, it is because the ICD-10 code M54.5 for Low Back Pain is now deleted effective all date of service from October 1, 2021! So make sure you are aware of this and correct your claims by choosing the billable and appropriate ICD-10 code that will describe your deleted code M54.5. Belo are some potential code replacements that you can use beginning October 1, 2021
Insurance Prior Authorization Services, Patients Access and Medical Documentation Reviews and Audits. New Codes you can potentially use:  Low Back Pain ICD-10 M54.5 DELETED EFFECTIVE OCTOBER 1, 2021 Remember that when changes like this happens, this is not just for CMS Medicare claims but it applies to all commercial payers (at least the big insurance payers!). Read more about this updates and change by clicking here https://www.cms.gov/medicare/icd-10/2022-icd-10-cm  CPT 64451 64625 BILLING CODING L5 DORSAL RAMUS AND S1, S2, S3 LATERAL BRANCH BLOCK and RADIOFREQUENCY ABLATION OR RHIZOTOMY What is CPT Code 64451? This is for the Block 64451, Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or CT computed tomography), should be reported once for this procedure. The fluoroscopic guidance should not be separately reported as it is included in the work described with code 64451.
When you do your RFA or Radio Frequency Ablation, what CPT Code do you need to use? Read below: CPT CODE FOR SACROILIAC SI RFA FOR 2020 CPT 64625 January 1, 2020 - we now have a new Pain Management Code CPT 64625 - SI Ablation Description of CPT Code 64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with imaging guidance (Fluoroscopic or Computed Tomography). Keypoints to REMEMBER!
Billing for the Genicular Nerve Branches RFA have been a struggle since it was not too clear to us on how we should be billing for this service. The good news is, we have a new code for this effective January 1, 2020. New CPT 2020 Changes. New Pain Management 2020 Codes. When your physician is performing an RFA on Genicular nerves, use code 64624 (Destruction by neurolytic agent of genicular nerve branches). Take note of the word "branches". These changes are explained as follows: Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency), Chemodenervation on the Somatic Nerves CPT CODE 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed (Do not report 64624 in conjunction with 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed Pay attention to this, the CPT 64624 requires the destruction of each of the following genicular nerve branches: (make sure your Provider had documented this!)
If a neurolytic agent for the purposes of destruction is not applied to all of these nerve branches, you can report CPT 64624 but you MUST append the MODIFIER 52: 64624-52 What is Modifier 52? Modifier 52 is usually used for reduced services. It may occur under certain circumstances that a service or procedure is partially reduced or eliminated at the physician’s discretion. There can be several reasons behind the physician’s decision. In this situation, service provided can be identified by its usual procedure number and the addition of the modifier 52, which indicates that the service was reduced. Understanding the 3 Genicular Nerve Branches of 64624 Image Source: https://ainsworthinstitute.com/genicular-neurotomy/ What is the CPT code for Knee Genicular Nerve Branches Block or Injection?Understanding the 3 Genicular Nerve Branches of 64454 Source: https://ainsworthinstitute.com/genicular-neurotomy/ When your Physician is Blocking the Knee Genicular Nerves - here's your code: (pay attention with the imaging! it is included!). CPT 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches; (make sure your Provider had documented this!)
If all 3 of these genicular nerve branches are not injected, report 64454 with Modifier; 64454-52 What is Modifier 52? Modifier 52 is usually used for reduced services. It may occur under certain circumstances that a service or procedure is partially reduced or eliminated at the physician’s discretion. There can be several reasons behind the physician’s decision. In this situation, service provided can be identified by its usual procedure number and the addition of the modifier 52, which indicates that the service was reduced. Article Source: CPT Assistant December 2019 page 8 Destruction by Neurolytic Agent (Genicular Injection; Radiofrequency Neurotomy Sacroiliac Joint) For Current Procedural Terminology Got additional questions or concerns? call us today! Billing Tip: Always make sure you understand and you know the Medical, Clinical, Utilization and Reimbursement Policy of your Payers. Read other blog posts:HOW TO BILL FOR 20553 WITH 76942 ULTRASOUNDPAIN MANAGEMENT NERVE BLOCKS January 1, 2020 - we now have a new Pain Management Code CPT 64625 - SI Ablation
Description of CPT Code 64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with imaging guidance (Fluoroscopic or Computed Tomography). Keypoints to REMEMBER!
Need help? Contact our office today! Some of my Pain Practice Offices are still confused on how to bill for MILD Procedure. As we all remember, there was no assigned CPT Code for this procedure, we used to report the unlisted code. In this Blog, I will describe the billing and coding for this procedure using the Vertos Device (www.vertosmed.com First, let's describe what is MILD? MILD stands for MINIMALLY INVASIVE LUMBAR DECOMPRESSION. HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION  HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION CPT 0275T is a Category III Code assigned for this procedure. 0275T - Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy, and/or foraminotomy), any method, under indirect image guidance (eg. fluoroscopic, CT), single or multiple levels, unilateral or bilateral; lumbar. (For percutaneous decompression of the nuleus pulposus of intervertebral disc utilizing needle based technique, use 62287) So how do you report and bill for this MILD Procedure? Billing on HCFA 1500 form? Physician Claim:
The following information has to appear and included in your claim submission:
Insurance Prior Authorization Services, Patients Access and Medical Documentation Reviews and Audits. My additional recommendation (especially for Medicare beneficiaries): Enter the "referring physician" on Box 17 the same as the "rendering physician" on Box 24J since the assessment and treatment plan is that from the "Rendering Physician".  Image/Guidance Source: www.vertosmed.com  HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION 2022 GUIDANCE HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION BILLING GUIDANCE for the Procedure (NCTØ3Ø72927) - SOURCE VERTOS (SEE ATTACHMENT BELOW)
Video Source is owned by: VERTOS MED - www.vertosmed.com Do you need additional help with billing?How to Negotiate your Physician Group or Individual Provider's Contract with the Insurance Payers  Many physician groups or even individual solo practice offices are not happy with their contracted rates or the way they are being reimbursed by the insurance payers? Is it time to negotiate? when is the best time to negotiate your contract? There is no better time than NOW! But there are important steps that you need to do before doing so. Negotiating your contract is not only by picking up the phone and calling the insurance payer's provider services department and asking them that you would like to negotiate your contracted fees. Unfortunately, it doesn't work that way! But there are important steps that you need to do before doing so. Negotiating your contract is not only by picking up the phone and calling the insurance payer's provider services department. It doesn't work that way! Here are my tips: How to Negotiate your Physician Group or Individual Provider's Contract with the Insurance Payers
You need to present your reasoning why you think its time to negotiate your fees! All of the above, you can present it to the Insurance Payer through the Network Area Manager. Put them all together. Document everything! You can initiate the process by calling, and then by sending a formal letter of intent to renegotiate your contract rates or fee schedule. Don't forget to involve your billers and coders in this project! Let your patients leave feedback, reviews and about their experience in your practice! All these will surely help get you a better deal. It's a bit of a process but just be patient and work on it.  Do you need help on how to Negotiate your Physician Group or Individual Provider's Contract with the Insurance Payers? You should contact us today! |
ABOUT THE AUTHOR:
Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant. 
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