CPT Codes For Pain Management Procedures

Billing and coding have always been complex, and because new changes are constantly getting introduced, they are only becoming more of a challenge.

For example, millions of people are suffering from chronic pain with the solution being pain management. However, this means that there are new pain management medical billing guidelines medical professionals should be aware of. 

Today, we’re going to describe the latest changes in pain management medical billing guidelines, and also address the CPT codes for some of the most common pain management methods.

What’s New in 2022?

For starters, let’s take a look at which codes were eliminated and replaced with more detailed ones. We can officially say goodbye to:

01935: Anesthesia for the transcutaneous image-guided diagnostic surgeries performed on the spinal cord or the spine.

01936: Anesthesia for the transcutaneous image-guided therapeutic surgeries performed on the spinal cord or the spine.

The new codes provide more granularity and identify the type of procedure for which the anesthesia is being used, as well as clarify the location of the procedure.

These are the new codes:

01937: Anesthesia for transcutaneous image-guided procedures such as injection, drainage, or aspiration to the thoracic spine or the spinal cord.

01938: Anesthesia for transcutaneous image-guided procedures such as injection, drainage, or aspiration to the sacral or lumbar spine or spinal cord.

01939: Thoracic or cervical anesthesia for transcutaneous destructive image-guided treatments of the spinal cord or spine.

01940: Sacral or lumbar anesthesia for transcutaneous destructive image-guided treatments of the spinal cord or spine.

01941: Thoracic or cervical anesthesia for transcutaneous image-guided neuromodulation or intravertebral surgeries on the spinal cord or spine.

01942: Anesthesia for intraverbal and sacral transcutaneous image-guided neuromodulation or intravertebral surgeries.

64628: Thermal destruction of the first two vertebral bodies, lumbar or sacral, or intraosseous basivertebral nerve including imaging guidance.

64629: Thermal destruction under imaging guidance on the intraosseous basivertebral nerve. This code should be used for each additional sacral or vertebral body treated after the first session.

93319: 3D echocardiographic imaging and post-processing during transesophageal echocardiography or transthoracic echocardiography for congenital cardiac anomalies for the evaluation of cardiac structure(s), including cardiac chambers and valves, the left atrial appendage, the interatrial septum, and the interventricular septum, when carried out (list separately in addition to code for echocardiographic imaging)

Pain Management Medical Billing Guidelines and CPT Codes

Managing chronic pain has always been a goal for medical professionals, and thankfully, Medicare now covers new pain management treatments such as acupuncture. Let’s see which codes are used most frequently for different methods of pain management.

1. Dry needling

Dry needling is an effective method for treating musculoskeletal ailments in which a certified physical therapist uses a thin monofilament needle to target muscular trigger points. Doing so treats musculoskeletal pain or mitigates any movement impairments. 

In contrast to acupuncture, an Eastern medicine method, dry needling was developed through western medicine’s understanding of posture, evaluation of pain patterns, movement function and impairments, and orthopedic tests.

As such, it has the corresponding CPT codes:

20550: tendon sheath injections

20551: injection to the tendon’s origin or insertion

20560: needle insertions to one or two muscles not including injections

20561: needle insertions to at least three muscles not including injections

According to the current pain management medical billing guidelines, trigger point injections (20552/20553) cannot be recorded with the procedures performed on the same muscle group with the codes 20560 and 2056. 

2. Acupuncture

A mainstay in Chinese medicine, acupuncture involves inserting thin needles into the skin at strategic points in your body. It’s most commonly performed as a way to treat pain or manage stress. According to traditional practitioners, along with relieving pain, acupuncture restores the energy of the body and activates its natural healing mechanisms.

It’s usually performed to relieve discomfort for multiple conditions such as dental pain, neck pain, osteoarthritis, tennis elbow, and many more.

Regarding chronic lower back pain, Medicare now covers acupuncture as a pain management treatment for up to 12 sessions over 90 days. The CPT codes used for acupuncture are the following:

97810: Acupuncture performed with needles without electrical stimulation. Used for the initial 15 minutes of one-to-one contact with the patient

97811: Covers re-insertions and additional 15 minutes of contact with the patient. 

97813: Acupuncture performed with needles and electrical stimulation. Used for the initial 15 minutes of one-to-one contact with the patient.

97814: Covers re-insertions and additional 15 minutes of contact with the patient. 

Data for coding acupuncture procedures are not based on the intensity but rather on 15-minute increments of contact with the patients. The latest pain management medical billing guidelines clearly state when each code should be used. 

When there is no electrical stimulation during the 15-minute increment, the appropriate codes are 97810 or 97811. If any electrical stimulation is used on the needles, the codes 97813 or 97814 are more appropriate.

Keep in mind that you should only use one code per 15-minute increment with codes 97810 or 97813 being appropriate for the first interval. You can also only report one initial code each day.

3. Radiofrequency ablation 

By delivering an electric current to an area of the body, it’s possible to prevent pain signals from traveling through a region of nerve tissue. This treatment is called radiofrequency ablation (RFA) and it can ease chronic pain and discomfort in the lower back area, neck, and arthritic joints. 

RFA can be performed under mild sedation in which the patient is kept conscious and can describe the feelings during the stimulation of the nerve. 

The pain management medical billing guidelines codes for RFA are:

64625: Image-guided RFA for the sacroiliac joint

64999: Unlisted nervous system procedure

For nerve ablation with conventional or cooled radiofrequency of 80 degrees Celsius, you should use the code 64625. To report pulsed RFA, use the code 64999.

4. Using modifiers

Wrong modifiers usually result in denied claims, so it’s important to brush up on pain management medical billing guidelines and modifiers such as:

Modifier 50: Use for reporting bilateral procedures

Modifier 52: Use for reporting incomplete procedures, for instance - postponing a part of the procedure

Modifier 53: Use for reporting incomplete procedures, postponed for the patient’s safety

Modifier 59: Use to signify the distinction of the procedure from other services performed on the same day

The Evolution of CPT Codes

With so many useful methods of treating chronic pain finally being part of Medicare, it’s natural that we would get new codes for reporting the same procedures. However, the evolution of new CPT codes isn’t limited only to new methods of treatment.

The new codes getting introduced is a great way to avoid any confusion and to supply more detailed information that ensures medical billing is on point. It makes certain that, as a physician, you are paid adequately for the medical service you provided.

If you have any medical bills that need to get reviewed, MBA should be your go-to option.

Additionally, if you have any questions regarding the new pain management medical billing guidelines or CPT codes, feel free to fill out our contact form and we’ll help clear up any confusion regarding any type of medical bill.