Effective Jan 1, 2017, there are a number of changes for pain management billing.  The AMA has added and deleted a number of billing codes.  Following are the pain management coding changes for 2017:

 

New Epidural Codes – Cervical or Thoracic

The following are new injection codes for diagnostic or therapeutic substances, not including neurolytic substances with needle/ catheter placement; epidural

 

CPT 62320 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance

 

CPT 62321 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (CT or fluoroscopy)

 

(Do not report 62321 in conjunction with 77003, 77012 76942)

 

Deleted

CPT 62310 Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic

 

Financial Impact – New Epidural Codes – Lumbosacral

62310 – 2016 Medicare FS $284.09*

62320 – 2017 Medicare FS $190.85*

62321 – 2017 Medicare FS $288.96*

 

*Note these are Non-Facility Rates for Southern California just for comparison. Contact us for complete rates for both facility and non-facility by Medicare locality.

 

New Epidural Codes – Lumbosacral

The following are new injection codes for diagnostic or therapeutic substances, not including neurolytic substances with needle/ catheter placement; epidural

 

CPT 62322 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance

 

62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (CT or fluoroscopy)

 

Deleted

CPT 62311 Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic

 

Financial Impact – New Epidural Codes – Lumbosacral

62311 – 2016 Medicare FS $263.64*

62322 – 2017 Medicare FS $179.07*

62323 – 2017 Medicare FS $284.78*

 

*Note these are Non-Facility Rates for Southern California just for comparison. Contact us for complete rates for both facility and non-facility by Medicare locality.

 

New Spine Injection Codes – Cervical or Thoracic

The following are new codes for injection including catheter placement continuous infusion/ intermittent bolus, of diagnostic or therapeutic substances, not including neurolytic substances; epidural

 

CPT 62324 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance

 

CPT 62325 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (fluoroscopy or CT)

 

Financial Impact – New Spine Injection Codes – Cervical or Thoracic

62318 – 2016 Medicare FS $270.62*

62324 – 2017 Medicare FS $164.29*

62325 – 2017 Medicare FS $252.63*

 

*Note these are Non-Facility Rates for Southern California just for comparison. Contact us for complete rates for both facility and non-facility by Medicare locality.

 

New Spine Injection Codes – Lumbosacral

The following are new codes for injection including catheter placement continuous infusion/ intermittent bolus, of diagnostic or therapeutic substances, not including neurolytic substances; epidural

 

CPT 62326 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance

 

CPT 62327 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (fluoroscopy or CT)

 

Financial Impact – New Spine Injection Codes – Lumbosacral

62319 – 2016 Medicare FS $194.66*

62326 – 2017 Medicare FS $174.35*

62327 – 2017 Medicare FS $260.17*

 

*Note these are Non-Facility Rates for Southern California just for comparison. Contact us for complete rates for both facility and non-facility by Medicare locality.

 

 

Source: AMA

 

About Apache Health

Apache Health is a revenue cycle management (RCM) analytics, benchmarking, and auditing company. The founders of Apache formerly ran a large RCM company that was acquired by a private equity group in a rollup. Apache’s predictive analytics will benchmark billing performance and project exactly how much more revenue you should earn from your existing volume of patients.  Using many factors and a blend of artificial intelligence and specialty specific benchmarks, the model projects whether changing the billing process would improve collections for your particular mix of procedures and payers. Apache Health can help you evaluate whether to outsource the billing, determine which billing company to select to maximize performance, or track inhouse billing performance improvement over time. For more information contact:

Sean McSweeney

Apache Health

www.apachemedicalbilling.com

888-422-5514