Pain management is a fast-growing, crowded, and complex field. Regardless of the specialty, the coding and significant reimbursement challenges are the same. In-office or in the ASC, most pain procedures are subject to detailed and often restrictive payor coverage policies. Physicians who remain unaware of these policy specifics do so at their peril. This one-day, intensive and fast-paced course covers the most critical issues for this unique specialty, and is packed with the knowhow and necessary tools for successfully getting paid and effectively managing the bottom line.
We'll start with coding and reimbursement essentials such as Medicare rules and 2017 updates - including Medicare’s push for quality programs, 2017 imaging bundling, CCI edits, and the payment structure of RVUs. If you are compensated by RVUs, it's imperative that you learn the basic steps and financial metrics that enable you to track your RVU productivity. Next, using actual payor coverage polices for pain treatment, you'll learn how to incorporate policy guidance into your daily practice and process. We’ll dissect the clinical criteria and diagnosis codes that form these policies, and the must-have documentation to justify coverage.
In this interactive portion of the course, we'll devote a large portion of the day to interventional procedure coding for spine, joint, soft tissue, tendon and nerve block injections, PRP injections and more. You'll learn to code using real case examples. Also included in the session is detailed guidance on E/M coding and the principles of proper billing for nurse practitioners and physician assistants.
Who should attend?
- Anesthesiologists, neurosurgeons, orthopaedists and PM&R physicians who deliver interventional pain services and procedures.
- Other providers, managers, billers, and coders who work in pain management, PM&R and orthopaedic neurosurgical practices that treat pain.
Upon completion of this activity, participants will be able to:
- Define documentation risk areas and understand how to improve them.
- Comply with coding and payor rules when coding pain encounters.
- Demonstrate comprehension of Medicare’s incident to billing, direct and shared/split visit guidelines.
- Apply coding rules and principles for reporting E/M and in-office procedures for pain services to avoid audits.
- Choose appropriate codes and modifiers for interventional procedures for spine, joint, soft tissue, tendon, and nerve block injections.
- Adapt interventional pain coverage policies into the practice's reimbursement process.
- Explain reimbursement basics, Medicare updates, and incident-to billing.