Pain Management Coding
Princess Padilla CCS CPC CANPC COSC
Pain Management Procedures
 Injections
 Destruction by Neurolytic Agent
 Intrathecal Catheters with Subcutaneous
Pump Delivery Systems
 Spinal Neurostimulators
 Epidural Neurolysis
 IDET – Intradiscal Electrothermal Therapy
Steps to Pain Coding
 Know the approach
Epidural
Transforaminal
Facet
• Know the type of injection
Anesthetic
Steroid
Neurolytic agent
Steps to Pain Coding
 Know the regions treated
Regions: cervical
thoracic
lumbar
sacral
 Know the levels treated
One or Multiple
Steps to Pain Coding
 Know the injection restrictions
Unilateral or Bilateral
 Know when fluoroscopy/ultrasound guidance
reporting is allowable
 Know the global days
Anatomy of Spinal Cord
 Covered by 3 layers of protective
membranes:
Outside to Inside:
Dura Mater
Arachnoid Mater
Pia Mater
Anatomy of Spinal Cord
 Epidural – located over or upon dura mater
 Subdural – Beneath the dura mater
 Subarachnoid – Beneath the arachnoid mater
 Intrathecal –
intra “within on inside”;
thecal of relating to a sheath
INJECTIONS
 Epidural injections
The approach for an epidural injection is
directly into the epidural space between
vertebrae. The purpose is to relieve cervical
or neck pain; thoracic or midback pain;
lumbar or low back pain.
Epidural Injections
 AKA: Interlaminar, Interlaminar epidural, ESI,
Translaminar Epidural,
Standard Epidural
 CPT CODES 62310 – 62319
√ Imaging
X Bilateral
X Multi - level
Epidural Injections
 Block VS Indwelling
 01996 Daily hospital management of epidural
or subarachnoid continuous drug
administration
Nerve Anesthetic Blocks
 (Nerve blocks) may be reported on the date
of surgery if performed for postoperative pain
management.
 Nerve block codes should not be reported
separately on the same date of service as a
surgical procedure if used as the primary
anesthetic technique or as a supplement to
the primary anesthetic technique.
Nerve Anesthetic Blocks
 Modifier 59 may be utilized to indicate that a
nerve block injection was performed for
postoperative pain management, rather than
intraoperative anesthesia, and a procedure
note should be included in the medical
record.
Nerve Anesthetic Blocks
 AKA: Nerve Blocks
CPT CODES 64400-64530
√ Imaging
√ Bilateral
√ Multi - level
Transforaminal Injections
 The approach for a transforaminal injection is
by way of the intervertebral foramen. There
are two foramen for each vertebra on
opposite sides of the spine.
 The needle is inserted to gain access to the
epidural space and nerve root.
Transforaminal Injections
 AKA: Steroid Anesthetic Agent;
Transforaminal Epidural
 CPT CODES 64479 – 64484
X Imaging
√ Bilateral
√ Multi – level
Facet Joint Injection
 AKA: Paravertebral Spinal Nerve; Medial
Branch Nerve; Facet Joint Nerve Injections
CPT 64490 – 64495
X Imaging
√ Bilateral
√ Multi – level
Destruction by Neurolytic Agent
 Radiofrequency ablation procedures are
reported with the appropriate destruction
codes. CPT 64600 - 64636
Includes
chemical e.g. Phenol, Alcohol
thermal
electrical
radiofrequency
Destruction by Neurolytic Agent
X Imaging
√ Bilateral
√ Multi – level
Chemodenervation Injections
 Chemodenervation of muscles in the face,
neck, extremity(s) and/or trunk.
 These services may involve injections of
single muscle groups or multiple muscle
groups.
Chemodenervation Injections
 AKA BOTOX injection
CPT CODES 64611-64614
√ X Imaging
√ X Bilateral
√ X Multi – level
Injection Documentation
• Each Level in title and verbiage of report
• Image guidance used and image kept
Needle placement based on image
where it entered
Where the medications are going
Sources
 ASA Relative Value Guide
 AMA CPT
 2012 Coding Changes for Pain Management
– Marvel Hammer RN CPC