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39 Coding & Billing Educate physicians and staff Ambulatory surgery centers are on the front lines of the nation's chronic pain epidemic. An estimated 100 million Americans live in chronic pain, a condition that is expected to cost as much as $635 billion in annual treatment ex- penses and lost productivity, according to the In- stitute of Medicine. Pain management is unique among the various specialty areas of medicine typically performed at ASCs. From a clinical standpoint, chronic pain frequently can only be managed, not cured. That means, unlike a bad knee or hip, an outpatient procedure often does not alleviate all of a pain sufferer's symptoms. Complicating matters, the underlying issue that's causing the pain might not always be clear. Pa- tients also return frequently for follow-up ap- pointments, so their physicians can check on their progress. Some physicians also aggressively treat pain sufferers, while others are more conservative in their approach. These differences in clinical care extend to an ASC's billing and coding operations. For example, most payers limit radiofrequency ablation, a common long-term pain management procedure for chron- ic pain sufferers, to once every six to 12 months. Meanwhile, it's not uncommon for physicians to recommend the procedure more frequently for some patients. The result? Unhappy patients and lost revenue. Some payers also limit the number of spinal injection procedures that can be performed on a patient in a year or during a lifetime. Making sure that you know and understand payer policies regarding these procedures can help limit denials. This discrepancy is just one of the many reim- bursement issues unique to treating chronic pain sufferers. Here are four best practices for prevent- ing potential pain management billing and cod- ing issues at your ASC: Document correctly Documentation is paramount. Without proper documentation by physicians, pain management procedures can be deceptively difficult to code. Insufficient documentation requires follow-up queries with doctors, which causes them to take additional time out of their busy days, creates oper- ational inefficiencies and delays billing – or worse. For example, medial branch nerve injections. While these injections are performed at the pair of medial branch nerves that innervate the facet joint, physi- cians need to clearly document exactly which nerves, or at which facet joint(s), these injections are being performed to ensure the proper number of levels injected are being coded. Not being specific in these cases can result in over coding (too many levels) or under coding (too few levels), which could result in overpayment or under payment. Relate coding to the bottom line Open communication between physicians and staff can make or break a busy ASC. For coding and billing departments, it's imperative to meet regularly with physicians to discuss current issues and process bottlenecks that may be hindering a facility's productivity. Structured seminars are a Understanding the Art and Science of Pain Coding By Tamara Wagner, Vice President, Coding, National Medical Billing Services and Alison Kuley, Coder, National Medical Billing Services ANTICIPATE CHANGE. WE DO. 636.273.6711 | www.nationalASCbilling.com The ASC Revenue Cycle. It's all we do. It's all we think about. And it shows. Hospital Review 150 Great Places to Work in Healthcare 2015