Specialties
Medical billing for pain management
Interventional pain procedures are well paid and closely audited. Most denials come from coverage criteria that weren’t documented before the procedure, not from coding.
What makes pain management billing hard
- Coverage criteria. Medicare and many commercial payers set conditions for epidural injections, facet procedures and radiofrequency ablation: how long the pain has lasted, which conservative treatments have failed, diagnostic block results and how often the procedure may be repeated.
- Imaging guidance. Fluoroscopic or CT guidance is already included in many injection codes. Billing it separately is a common, avoidable denial.
- Levels and sides. Multiple spinal levels and bilateral procedures are coded with add-on codes and modifiers that vary by procedure and by payer.
- Drugs and supplies. Injected drugs are billed in units by dose, and a wrong unit count causes underpayment or denial.
- Urine drug testing. Screening and confirmatory tests need documented medical necessity and are a frequent audit target.
How we work it
Before a procedure is scheduled we check the payer’s criteria against the chart and request authorization where it’s required. Procedure claims are reviewed for bundled guidance, levels, sides and drug units, and repeat procedures are checked against frequency limits.
Common questions
Why was our radiofrequency ablation denied?
Most often because the required diagnostic blocks, or the pain relief they produced, weren’t documented the way the payer’s policy requires. Checking that before scheduling prevents the denial.
Can fluoroscopic guidance be billed with an epidural injection?
For many injection codes it can’t, because guidance is already included in the procedure code. We check each code so guidance is billed only where it’s actually payable.
Start with the free audit
Send us ninety days of claims data and we’ll show you what was left uncollected. No charge, no obligation, and the findings are yours either way.
Request my free audit