2022 ASC Coding Tips: Pain Neuromodulation Documentation Improvements
By Mary Reilly, CPC, COC, CASCC, Coding Manager
Pain neuromodulation is the use of electrical therapies to treat pain. These procedures typically have limited insurance coverage criteria and use specific and expensive implants. Making sure these procedures are reimbursed correctly and in a timely manner can be dependent upon compliant and informative documentation.
Pain Diagnosis Coding
“Chronic pain” and “chronic pain syndrome” are coded differently and have different coverage criteria. If your patient suffers from chronic pain syndrome, use the correct coding verbiage.
Complex regional pain syndrome (CRPS) has two subtypes: type I and type II. There is no code for CRPS without specifying a subtype. If a subtype is not documented, the coder will need to query the performing physician. Including the subtype and extremities affected by CRPS in your documentation will allow the coder to assign the most specific code.
Pain neuromodulation involves implants which have their own codes and may be separately reimbursable from the procedure. There are commonly two types of implants: leads and generators.
Leads: The HCPCS codes for leads depend on whether the leads are temporary trial or permanent. Include this distinction in your documentation for accurate coding.
Generators: The HCPCS codes for generators depend on whether they are rechargeable, non-rechargeable, and/or high-frequency. Document this information along with the brand and model number of the generator so the coder can assign codes without needing to request and review the implant log.