- Category Codes
- Frequent CPT Codes
- Chronic Care Management
- Evaluation and Management
- Coding Updates
Coding effectively requires knowledge of the basic framework of how codes are set up. There are three main CPT coding categories. Becoming familiar with them and understanding the category will help with chronic management code selection. It will also assist with coding accuracy and capturing specific codes in addition to the primary code.
Category I Codes
Category II Codes
Next are Category II: These are tracking codes that are supplemental codes used for performance measurement. These codes are optional and are not required for correct coding.
An example of this would be 0521F (Plan of care to address pain documented (COA) (ONC)
Category III Codes
No long term commitments.
Frequent Pain Management CPT codes
Injections administered into the tendon sheath or ligament are also called trigger point injections. Trigger points are painful knots in the muscle that form when the muscle fails to relax in cases of exhaustion or injury.
- Carpal tunnel (G56.00) is a condition that is often treated by an injection of steroids
- Therapeutic injection (20526) is an injection of a substance such as an anesthetic, or corticosteroid done for carpal tunnel
For joint aspiration a needle is inserted through the skin and into a joint or bursa, then the syringe attachment to the needle is used to remove fluid. For joint injection a drug is injected into the joint for therapeutic purposes. This procedure is performed without using ultrasound guidance.
- Osteoarthritis (M19.90) is often treated with this method)
- Major joint/bursa: 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa is usually done for osteoarthritis
For nerve blocks, the provider injects an anesthetic and/or steroid close to the nerve, which anesthetizes the area supplied by the nerve. Occipital neuralgia (M54.81) is an example of a condition treated by a nerve block.
- Greater occipital neuralgia (M54.81) is an intense nerve–related headache pain often due to trauma to the nerves at the back of the head, or cervicogenic headaches
- Greater occipital block (64405) The provider performs this procedure to relieve occipital neuralgia by injecting an anesthetic and/or steroid agent into the greater occipital nerve
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Chronic Care Management
Chronic care management (CCM) services are generally non-face-to-face services provided to Medicare beneficiaries who have two or more chronic conditions that are expected to last at least 12 months, or until the death of the patient. CPT guidance may vary from payer reporting guidelines, so it is important to check each payer’s policies.
Before CCM services can start, an initial visit “comprehensive” E/M visit, annual wellness visit (AWV) or initial preventive physical exam (IPPE) for new patients or patients who have not been seen within 1 year should be performed.
Complex Care Management
Complex care management shares common required service elements with CCM but also have different requirements. In addition to the CCM required elements, at least 60 minutes of care must be provided. Another difference is the requirement of moderate to high decision making.
There are common conditions that are typically billed with CCM codes. The chronic conditions include but are not limited to:
- Alzheimer’s disease and related dementia
- Arthritis (osteoarthritis and rheumatoid)
- Atrial fibrillation
- Autism spectrum disorders
- Cardiovascular disease
- Chronic Obstructive
- Pulmonary Disease (COPD)
- Infectious diseases like HIV and AIDS
CCM Evaluation and Management
Chronic Pain management is billed with codes 99490-99491, and complex care services are billed with codes 99487- 99489. Below are the details of each code set:
- 99490- Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; these are chronic conditions that place the patient at significant risk of death. Some other conditions are exacerbation/decompensation, or functional decline.
- 99491- Chronic care management services, provided personally by a physician or other qualified healthcare professional, at least 30 minutes of physician or other qualified healthcare professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
- Medicare introduced an additional code for chronic care management in 2020. HCPCS Code G2058. This is reported with 99490 and describes an additional 20 minutes of work.
- Providers who perform an extensive assessment outside of the usual requirements can also bill the add-on HCPCS code G0506. Providers can only bill G0506 once in addition to the initiating visit. Time spent on CCM services cannot be counted toward any other code billed.
Complex Care Management Codes
- CPT code – 99487 complex CCM is a 60-minute timed service provided by clinical staff to substantially revise or establish comprehensive care plan that involves moderate- to high-complexity medical decision making
- CPT code 99489 is each additional 30 minutes of clinical staff time spent providing complex CCM directed by a physician or other qualified healthcare professional (report in conjunction with CPT code 99487; cannot be billed with CPT code 99490)
Coding Updates for Chronic Pain for 2023
CMS has made a few changes for CPM (chronic pain management) that take effect January 2023. Some of the changes include an addition of two new HCPCS management codes G3002 and G3003. These services can be billed by a physician, nurse practitioner, physician assistant, or eligible qualified health care professional.
CMS recognizes that HCPCS codes G3002 and G3003 are distinct from other care management services like Chronic Care Management. The new chronic pain management and treatment codes are similar to chronic care management codes currently being billed. CPM includes all the services performed each month to help the patient manage their pain.
The CPM codes can be reported by specialty providers who are outside of pain management. These codes can also be used by primary care providers who focus on long-term pain management. Both codes can also be billed with an office visit, but the time for each code cannot be combined. Documentation for each code should include Medicare requirements as much as possible. This will vary as it pertains to the patient.
The code descriptors for each code are listed below:
G3002 is defined as:
Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. Required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes
G3003 is defined as:
“Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified healthcare professional, per calendar month (listed separately in addition to code for G3002). When using G3003, 15 minutes must be met or exceeded.
Another tip would be to pay attention to the provider’s documentation. This will be a guide for selecting codes accurately. Many times, there will be documentation that is unclear or missing, and in some instances make coding impossible. An example of this would be incomplete medical decision making. For issues like this it would be appropriate to query the provider to review and update if necessary. Capturing all the codes for an encounter is also important as this will maximize reimbursement.
As you can see, medical coding and billing for Chronic Pain Management is very complex with codes scattered between category I and category III of the AMA CPT codebook.
For assistance with this process, please do not hesitate to reach out to us directly. At Neolytix, we are always ready to assist your practice with medical billing, coding, and revenue cycle management.
Our medical billing services are 100% HIPAA-compliant and provided by a certified team of professionals. Likewise, our medical credentialing services are fast, efficient, and organized according to rigorous workflow management procedures.