Get the lowdown on when to code separately for fluoroscopy.

If your physician performs interventional pain management (IPM) services, you’ll need to be up to speed on four top IPM procedures to make sure you’re earning full deserved reimbursement for your claims.

Difference: Pain management specialists are physicians who study pain and perform less invasive injections (soft tissue, peripheral nerve, and joint injections) and medication management to help relieve patients’ pain. One common pain management procedure is trigger point injection (20552, Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) or 20553, single or multiple trigger point[s], 3 or more muscle[s]). An interventional pain management specialist’s scope includes spinal diagnostic and therapeutic procedures and other invasive techniques like nerve stimulator or opioid pump insertion, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. When submitting claims, you’ll use specialty designation 72 for pain management or 09 for interventional pain management.

Learn the Most Common Injections

All injections are not created equal – and they’re not coded the same. Here’s your guide to four types of treatments that commonly fall under the IPM umbrella.

Facet injections: CPT® includes a range of codes describing the various sites and levels associated with paravertebral facet joint and facet joint nerve injections. You’ll find these in code family 64490-64495 (Injection(s), diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT]). If your physician uses ultrasound guidance during the injection procedure, turn to the Category III code section of CPT® instead. There you’ll find codes 0216T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance). You’ll choose the appropriate code based on the anatomic injection site...

Use this cheat sheet to aid your non-congenital valve disorder coding

...

Modifiers and test results are among the ‘instant denial’ triggers for these codes.

Whether you search under medical oncology, hematology, or hematology/oncology, J0881 and J0885 rank first and third on the lists of the top 10 codes reported to the CMS database (2009). These J-codes for erythropoiesis stimulating agents (ESAs) carry a heavy load of very specific reporting requirements and volatile reimbursement rates. To be sure your claims for these frequently reported codes are as clean and accurate as possible, apply the tips below.

Learn more: These recently available top 10 rankings are listed in a file posted by Frank Cohen, MPA, principal and Senior Analyst for The Frank Cohen Group. Choose the link for “Top 10 procedure codes by frequency for all specialties” at www.frankcohen.com/html/access.html.

Warm Up With Code and ESA Definitions

The HCPCS codes in focus are as follows:

• J0881, Injection, darbepoetin alfa, 1 mcg (non-ESRD use)
• J0885, Injection, epoetin alfa (for non-ESRD use), 1000 units.

Code J0881 is appropriate to report the supply of Aranesp. Code J0885 applies instead to supply of Epogen or Procrit. Keep in mind that the J codes represent only the supply. You should report the ESA administration separately using 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for intramuscular (IM) administration, says Janae Ballard, CPC, CPC-H, CPMA, CEMC, PCS, FCS, coding manager for The Coding Source, based in Los Angeles.

Both codes indicate they are specific to “non-ESRD use.” ESRD is short for end stage renal disease. Consequently, these codes are appropriate when the injection is connected to oncologic use.

What ESAs do: ESAs stimulate bone marrow to produce more red blood cells, according to...