Does Your Practice Treat Pain?
AAOSNow – August 2019
by Cheryl Toth
Interventional pain management is a growing specialty, and many orthopaedic groups have added an interventionalist to the physician team. If this is the case for your practice, make sure the interventionalist understands the reimbursement and documentation nuances essential to optimizing payment and mitigating payer takeback risk.
“The biggest problem we see is that interventional pain physicians don’t follow payer coverage policies for medical necessity that dictate when they can perform an intervention and get paid,” said Teri Romano, BSN, MBA, CPC, CMDP, a senior consultant at Karen Zupko & Associates, Inc. (KZA). “From trigger point injections to joint injections to spine injections, payer coverage policies outline the criteria for meeting medical necessity. They are very specific and very detailed. Medicare and almost [all private payers] have them.”