Cracking Coding Rationale for Pain Management Part II

Cracking Coding Rationale for Pain Management Part II

As discussed last month, chronic pain is a significant health issue in the United States with more than one in five adults having experienced chronic pain. Globally, it is the number one cause of disability and disease. In November, we provided ten tips to help tackle coding rationale. Here are a series of more tips to help bolster success.

Actionable Tips and Rationale
  1. Fluoroscopic guidance is included in the descriptor, as this is an integral component of the procedure and would not be separately reported. To report percutaneous intradiscal annuplasty other than electrothermal, use CPT code 22899. IDET should be assigned code 22526 or 22527.
  2. Codes 22513–22515 are only to be reported once per vertebral body treated whether unilateral or bilateral therapies are performed. Do not code separately for bone biopsy performed at the same time as kyphoplasty.
  3. Report 61070 for injection of contrast into intrathecal pain pump (i.e., Baclofen pump) for catheter check. Fluoroscopic imaging would be reported with 75809.
  4. It is incorrect to use codes 22510–22515 for treatment of lesions of the sacrum or coccyx (i.e., sacroplasty). Category III codes 0200T and/or 0201T should be used for this service.
  5. The descriptors for codes 0071T and 0072T include guidance, so no separate charge should be submitted for this portion of the procedure. If a bladder catheter is submitted as part of this service, it is inappropriate to charge separately for that portion of the procedure as well.
  6. Report only once regardless of number of injections made. Do not report with code 64632. Use only for lower extremity procedures.
  7. Report only once regardless of number of injections made. Do not report 64632 with other injection codes in same anatomic location at same setting. Use only for lower extremity procedures.
  8. Assign Category III Code 0200T for unilateral sacroplasty or 0201T for bilateral sacroplasty. There is no separate image-guidance code that should be assigned in addition to the bundled codes for sacroplasty.
  9. Codes 0200T and 0201T include bone biopsy if performed. Do not also code 20225.
  10. Codes 0200T and 0201T include performance of a procedure utilizing a balloon or mechanical device.
  11. These are collapsed/bundled codes. Do not charge separately for fluoro, CT, or ultrasound guidance with these procedures.
  12. Do not exceed more than one unit of any of these codes for the same patient at the same session unless directed specifically by payer for bilateral procedures. Do not code for “each” additional level. Per CPT, when performed bilaterally, add-on codes are submitted twice, not once with modifier 50.
  13. Per CPT guidelines, T12-L1 transforaminal epidural, facet joint injection, or facet destruction by neurolysis should be coded as thoracic.
  14. These codes require CT or fluoroscopic guidance. If no guidance is used, code 64999.
  15. Only one initial vertebroplasty or kyphoplasty code may be assigned. For additional levels, report the appropriate “each additional” code. Per instructions found in Chapter 8, Section C of the NCCI Policy Manual for Medicare Services, “within each of these families of codes, the physician may report only one primary code and the add-on procedure code for each additional level(s), whether the additional level(s) is contiguous or not.”
  16. Per CPT, “do not report a code labeled as destruction when using therapies that are not destructive of the target nerve (i.e., pulsed radiofrequency) use 64999.”
  17. Two joint aspiration/injection code options exist for small, intermediate, or large joints. Assign 20604, 20606, or 20611 if ultrasound guidance is used. Do not also report 76942. If a guidance modality other than ultrasound is used, code 20600, 20605, or 20610 and add the modality-specific guidance code (77002, 77012, 77021).
  18. Paravertebral or paraspinous blocks are reported with codes 64461–64463. These codes describe medication injected or infused at the thoracic region to target the sympathetic nerve chains and somatic nerves, generally after thoracotomy, mastectomy, or in patients with rib fractures. The injection/ infusion is NOT into the epidural space and is not transforaminal, but is outside of the neuraxial canal to affect nerves as they exit from the neural foramen. The intention is to block several nerves at the same time. These codes include any type of imaging guidance, so do not also code a 7XXXX code. Do not report these codes with other spinal injections or nerve injections.
  19. Report code 64461 for the initial injection. Report add-on code 64462 for any additional injections on the same day. Neither code may be reported more than once a day. Do not code 64462 without 64461.
  20. When a catheter is placed for paraspinous block by continuous infusion or repeated intermittent bolus injections through the catheter, report code 64463. The catheter must be left in place during the course of the infusion.

These are not all the necessary coding tips and rationale essential for correct pain management coding and compliance. As service volumes rebound, now more than ever it is imperative to make sure your CPT® coding is correct and compliant. Master more interventional radiology topics and break down the complexity with expert-infused insight. Our 2022 Pain Management Interventional Radiology Coding webcast, available on-demand, is an essential training tool for both audio and visual learners.

Information source for chronic pain statistics:


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