1. Pain Management Coding
Princess Padilla CCS CPC CANPC COSC

2. Pain Management Procedures
Injections
Destruction by Neurolytic Agent
Intrathecal Catheters with Subcutaneous Pump Delivery Systems
Spinal Neurostimulators
Epidural Neurolysis
IDET – Intradiscal Electrothermal Therapy

3. Steps to Pain Coding Know the approach Epidural Transforaminal Facet
• Know the type of injection
Anesthetic
Steroid
Neurolytic agent

4. Steps to Pain Coding Know the regions treated Regions: cervical
thoracic
lumbar
sacral
Know the levels treated
One or Multiple

5. Steps to Pain Coding Know the injection restrictions
Unilateral or Bilateral
Know when fluoroscopy/ultrasound guidance reporting is allowable
Know the global days

6. Anatomy of Spinal Cord Covered by 3 layers of protective membranes:
Outside to Inside:
Dura Mater
Arachnoid Mater
Pia Mater

7. 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

8. 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.

9. Epidural Injections
AKA: Interlaminar, Interlaminar epidural, ESI, Translaminar Epidural,
Standard Epidural
CPT CODES – 62319
√ Imaging
X Bilateral
X Multi - level

10. Epidural Injections Block VS Indwelling
01996 Daily hospital management of epidural or subarachnoid continuous drug administration

11. 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.

12. 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.

13. Nerve Anesthetic Blocks
AKA: Nerve Blocks
CPT CODES
√ Imaging
√ Bilateral
√ Multi - level

14. 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.

15. Transforaminal Injections
AKA: Steroid Anesthetic Agent; Transforaminal Epidural
CPT CODES – 64484
X Imaging
√ Bilateral
√ Multi – level

16. Facet Joint Injection
AKA: Paravertebral Spinal Nerve; Medial Branch Nerve; Facet Joint Nerve Injections
CPT – 64495
X Imaging
√ Bilateral
√ Multi – level

17. Destruction by Neurolytic Agent
Radiofrequency ablation procedures are reported with the appropriate destruction codes. CPT
Includes
chemical e.g. Phenol, Alcohol
thermal
electrical
radiofrequency

18. Destruction by Neurolytic Agent
X Imaging
√ Bilateral
√ Multi – level

19. 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.

20. Chemodenervation Injections
AKA BOTOX injection
CPT CODES
√ X Imaging
√ X Bilateral
√ X Multi – level

21. 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

22. Sources ASA Relative Value Guide AMA CPT
2012 Coding Changes for Pain Management – Marvel Hammer RN CPC