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Category Codes
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
The first is Category I: These codes have descriptors that correspond to a procedure or service. This also includes devices, drugs, and vaccines. The codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy. An example of this would be 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting.
Other common CPT codes in primary care for injections include steroid injection CPT code 20610 for major joints or bursa and cortisone injection CPT code 20610 for treating inflammation in joints.
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
Category III: These are temporary codes for new and developing technology, procedures, and services. They were created for data purposes. An example of this would be 0095T (Removal of total disc arthroplasty (artificial disc), anterior approach, each additional interspace.
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2024 Coding Updates
Frequent Pain Management CPT codes
There are common CPT codes that are typically used for coding chronic care. Many treatments require an injection of medication injected into a certain site. Some common locations for this include joints, tendons, or nerves, just to name a few. Within those categories are further specificity of the location such as the shoulder or elbow.
Injections: Injections administered into the tendon sheath or ligament are also called trigger point injections. Trigger point injections CPT codes include 20552 for one or two muscle groups and 20553 for three or more muscle groups. Trigger points are painful knots in the muscle that form when the muscle fails to relax in cases of exhaustion or injury.
Example:
Carpal tunnel (G56.00) is a condition that is often treated by an injection of steroids.
Therapeutic injection CPT code 20526 is an injection of a substance, such as an anesthetic, or corticosteroid, done for carpal tunnel.
Corticosteroid injection CPT code 20610 is used for treating inflammation in major joints or bursa.
Joint Aspiration: For joint aspiration, a needle is inserted through the skin and into a joint or bursa, and 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.
Example:
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
Nerve Blocks: 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.
Example:
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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ICD-10 Pain Management Codes
Using the correct ICD 10 pain management codes is essential for accurate documentation and billing. For example, ICD 10 chronic pain codes like G89.29 are used for chronic pain management. Specific conditions such as chronic back pain are coded with ICD-10 code M54.5.
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.
In the past year we have experienced new changes for CPM (chronic pain management) that took effect January 2023. Some of the changes included 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.
Understanding Pain Management
Understanding the most common CPT codes for primary care and pain management medical billing is crucial. For example, the ICD-10 code for chronic pain is G89.29, and specific pain management ICD-10 codes like M54.5 (Low back pain) and G89.4 (Chronic pain syndrome) are essential for accurate coding. Additionally, the chronic pain management CPT code 99490 for chronic care management services is vital for proper billing.
Medical billing for pain management requires adherence to pain management billing guidelines, and using a medical billing and coding cheat sheet can help ensure compliance. For conditions like chronic back pain, the ICD-10 code M54.5 is commonly used.
Proper pain management coding guidelines 2024 and pain management coding guidelines 2023 must be followed to avoid errors. For procedures like therapeutic injections, CPT code 20526 is frequently used.
Interventional techniques like the occipital nerve block CPT 64405 are part of interventional pain management CPT codes. For joint and muscle pain, therapeutic injection CPT codes such as 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis) are commonly used.
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)
- Asthma
- Atrial fibrillation
- Autism spectrum disorders
- Cancer
- Cardiovascular disease
- Chronic Obstructive
- Pulmonary Disease (COPD)
- Depression
- Diabetes
- Hypertension
- 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)
Another tip would be to pay attention to the provider’s documentation. This will be a guide for selecting medical coding 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.
Incorporating Key Coding and Billing Information
Understanding and using the correct pain CPT codes is crucial for accurate billing and reimbursement. For instance, the G2211 CPT code description pertains to an office or other outpatient visit for the evaluation and management of a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making.
Accurate coding for chronic pain includes using the ICD-10 code for chronic pain, which is G89.29. Other relevant pain management ICD 10 codes include M54.5 for chronic back pain and G89.4 for chronic pain syndrome. Properly using these codes ensures compliance with CPT coding guidelines and optimizes billing processes.
For procedures like injections, the CPT code for trigger point injection is 20552, which is essential for treating muscle trigger points. The occipital nerve block CPT code 64405 is used for nerve block procedures, often necessary in pain management strategies.
In primary care, the CPT code for back pain might include 20610 for joint injections, and for knee pain, a similar CPT code for knee pain can be used depending on the treatment provided. Keeping an updated injection CPT code list and adhering to pain management coding guidelines 2023 and pain management coding guidelines 2024 is vital for accurate documentation and billing.
Providers must also be familiar with the chronic pain management CPT code 99490 and other CCM CPT codes 2023 to ensure they are billing for all the services provided. Proper billing for pain management services not only maximizes reimbursement but also ensures that patient care is thoroughly documented and managed.
Conclusion
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.
Frequently Ask Questions
Pain management services use various CPT codes depending on the specific procedures performed. Common pain management CPT codes include:
20610: Arthrocentesis, aspiration, and/or injection of a major joint or bursa
20550: Injection(s); single tendon sheath, or ligament, aponeurosis
64450: Injection, anesthetic agent; other peripheral nerve or branch
The ICD-10 code for unspecified pain is R52. However, specific types of pain have their own codes, such as:
M54.5: Low back pain
G89.4: Chronic pain syndrome
CPT codes for post-operative pain management may include:
64415: Injection, anesthetic agent; brachial plexus, single
01996: Daily hospital management of epidural or subarachnoid continuous drug administration
Coding for pain management diagnosis involves using ICD-10 codes that best describe the patient's condition. Examples of CPT code for pain management include:
G89.29: Other chronic pain
M79.7: Fibromyalgia
Pain management medical coding often requires familiarity with pain management CPT codes and ICD 10 pain management codes to ensure accurate documentation and billing. Using resources like the E&M coding cheat sheet 2024 can help streamline the coding process.
The ICD-10 code for chronic pain management is G89.29.
Three main types of pain management include:
- Medication management: Using analgesics, opioids, and other drugs.
- Interventional pain management: Techniques like nerve blocks (CPT code 64405), epidural injections, and radiofrequency ablation. Other procedures may include greater occipital nerve block CPT codes and therapeutic injection CPT codes.
- Physical and psychological therapy: Includes physiotherapy, counseling, and cognitive-behavioral therapy.
The ICD-10 code for opioid use disorder is F11.20 (Opioid dependence, uncomplicated). Proper pain management coding is essential to ensure accurate documentation and billing for treatments involving opioids.
Medical billing for pain management involves using the correct CPT codes for procedures performed and ICD-10 codes for diagnoses. Examples include:
- Therapeutic injection CPT codes like 20550
- Trigger point injection CPT code 20552
For comprehensive pain management billing services, it is important to stay updated with the latest pain management CPT codes 2024 and refer to resources like pain management cpt codes cheat sheet.
G codes are specific to Medicare. For example:
- G2211: Office or other outpatient visit for the evaluation and management of a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making.
The ICD-10 code for pain management involving opioids may include:
F11.20: Opioid dependence, uncomplicated
The ICD-10 code for pain due to medical devices is T85.84XA (Pain due to internal orthopedic prosthetic devices, implants, and grafts).
The ICD-10 code for unspecified pain discomfort is R52.
Chronic pain is classified under ICD-10 code G89.2 (Chronic pain, not elsewhere classified).
Chronic pain is coded using ICD-10 code G89.29 (Other chronic pain). It is important to use accurate pain management coding practices to ensure proper billing and reimbursement.
What is the code for chronic pain management?
For chronic pain management services, the relevant CPT codes are:
- 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
- 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
Staying updated with chronic care management CPT codes 2023 and pain management CPT codes 2024 ensures that practices are billing accurately and efficiently.
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