Documenting Medical Necessity for Pain Management Services

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Documenting Medical Necessity for Pain
Management Services
Claim Denials Due to Poor Documentation Pain
management billing is been regulated by various
agencies like the federal government, medical
boards, state government as well as many other
regulatory agents. While billing for pain
management, physicians follow applicable billing
guidelines and payer-specific policies to ensure
accurate insurance reimbursement. Still, pain
management claims might get denied due to
inaccurate documentation. Proper documentation of
all medical services with corresponding medical
codes and appropriate bills are important aspects
of pain management billing. While coding pain
management services physicians face various
challenges, some of them include reflecting
medical necessity portraying the location of
pain specifying the degree and type of pain and
following payer-specific documentation
guidelines. In this article, we will be focussing
on of the documentation challenge i.e.,
documenting medical necessity for pain management
services. Documenting Medical Necessity for Pain
Management Services
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Documenting Medical Necessity for Pain
Management Services

• In pain management services the most important
  deciding factor for reimbursement is the medical
  necessity for any medications or procedures. But
  for patients with chronic pain and other related
  illnesses, deciding the medical necessity of any
  treatment and then reporting it in the medical
  records can be a difficult task. Government and
  private insurance will reject any reimbursement
  claims for treatments that do not justify the
  medical necessity.
• For accurately documenting the medical necessity
  for pain management services, the severity or
  degree of pain must be portrayed accurately in
  order to justify the care provided. Other
  information such as the history of previous
  trauma or imaging findings can be supplemented
  with the pain description to state medical
  necessity. We shared basic Medicare guidelines
  that will help to document medical necessity
  appropriately.
• The patients medical record must contain
  documentation that fully supports the medical
  necessity for services. This documentation
  includes, but is not limited to, relevant medical
  history, physical examination, and results of
  pertinent diagnostic tests or procedures.

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Documenting Medical Necessity for Pain
Management Services

• A procedure note must be legible and include
  sufficient detail to allow reconstruction of the
  procedure. Required elements of the note include
  a description of the techniques employed, and
  sites(s) of injections, drugs, and doses with
  volumes and concentrations as well as pre-and
  post-procedural pain assessments.
• For injections of tendon sheaths, ligaments,
  ganglion cysts, carpal, and tarsal tunnels, the
  medical record must include a procedural note
  documenting the reason for the injection at any
  particular site. If multiple sites are injected,
  documentation to substantiate that all the
  injections are reasonable and necessary must be
  present.
• For SI joint injections specific requirements
  must include, documenting the total amount of
  injectate for all medications used. The amount of
  injectate should be such that the synovial lining
  of the joint is not burst and the injectate does
  not disperse beyond the confines of the target
  joint.
• For the treatment of the established trigger
  point, the patients medical record must clearly
  document
• The evaluation leading to the diagnosis of the
  trigger point in an individual muscle, as
  detailed in the payer policy.
• Identification of the affected muscle(s)
• Reason for selecting the trigger point injection
  as a therapeutic option, and whether it is being
  used as an initial or subsequent treatment for
  myofascial pain.

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Documenting Medical Necessity for Pain
Management Services
Pain management can be a stressful area in
healthcare as patient volume is constantly
rising. Millions of people suffer from chronic
pain globally. The estimated cost for the
management of chronic pain in the US alone is
more than 600 billion. Managing chronic pain can
be tricky as patients may often not respond
adequately to treatment. As physicians are
already burdened with care management, putting
the additional weight of insurance reimbursement
could be frustrating. Associating with medical
billing company could help physicians to focus on
patient care while their billing partner handles
the challenge of timely and accurate insurance
reimbursements. Medical Billers and Coders
(MBC) is a leading medical billing company
providing complete revenue cycle services. We can
manage complete billing services so that you can
focus on patient care only. To know more about
our pain management billing and coding services,
email us at info_at_medicalbillersandcoders.com or
call us at 888-357-3226.