Pain Management Billing Services for Interventional Pain Practices
Pain management is procedure billing under a lot of payer attention. Epidural steroid injections, facet joint procedures, radiofrequency ablation and spinal cord stimulators each have their own coding rules, frequency limits and documentation needs, and many need prior authorization first. Urine drug testing and chronic pain visits get reviewed too. We bill for pain management practices and interventional pain groups so high-value procedures are supported and paid.
Why pain procedures get denied
Six areas where payers push back.
Injection and block coding
Epidural, facet, nerve block and joint procedures are coded by level, region, laterality and technique. Imaging guidance is often included in the procedure, and bilateral and multiple-level rules decide how many units are payable.
Coverage policies
Many procedures have Medicare or payer coverage policies that spell out the diagnoses, prior conservative care, diagnostic block results and frequency limits required. When documentation is missing, claims get denied and, later, reviewed.
Approvals tied to codes, levels and dates
Many payers require authorization for epidurals, ablation and implants. Approvals cover specific codes, levels and dates, and a change in plan on the day of service can void them.
Modifiers and bundling
Laterality, bilateral, multiple procedure and distinct procedure modifiers affect payment on each line, and an E/M on the day of a procedure needs modifier 25 with documentation.
Stimulators and pumps
Spinal cord stimulator trials and implants, and intrathecal pumps and refills, involve device billing, staged procedures and facility versus office rules.
Drug testing and long-term pain care
Urine drug testing is reviewed for medical necessity and the level of testing done. Long-term opioid management and care management services have their own documentation and frequency requirements.
How we help pain practices
Take the full cycle, or just the parts where procedures stall.
Procedure benefits first
Ahead of the visit, eligibility verification confirms coverage, procedure benefits and any referral requirement.
Authorizations for injections and implants
Injection, ablation and implant requests are prepared and followed through prior authorization. We make sure the codes and dates on the claim match what was approved.
Levels, laterality and modifiers
The procedure note is checked by our medical coding team for the right code, level, laterality and modifiers.
Procedure, drug and supply charges
Charge entry picks up procedures, supplies, drugs and visits, and compares them with the schedule so none is missed.
Diagnosis support on every claim
Claims leave our claim submission team with the diagnosis support each procedure needs.
Medical necessity and frequency denials
Our A/R and denial team takes on denials for medical necessity, authorization, frequency and modifiers.
Enrolling new physicians
New physicians and mid-level providers are enrolled through credentialing, so they can bill from their start date.
Procedure volume against charges
Reporting covers A/R by payer, denials by reason and procedure volume against billed charges.
Your EHR and billing software
The clinic keeps its EHR and billing software. We log in securely and work there.
What starting with us looks like
A pain practice's first weeks, in five steps.
Review your procedure list
We look at the procedures you perform, where you perform them and the payers behind them.
Document the policies
We write down authorization triggers, coverage policy requirements and frequency limits for each payer.
Set up access
You give us secure access. We hand your team a documentation checklist for the common procedures.
Keep claims moving
Checks, coding review, claims, posting and follow-up get going on a schedule that suits your clinic.
Talk through denials
We sit down with your team to go over medical necessity denials, A/R and trends.
Related pages
Approvals before procedures
Epidurals and ablation often need an approval first. See our prior authorization services.
Denied procedures
Procedure denials need a plan. Our A/R and denial management team picks up what payers turn down.
Orthopedic patients
Orthopedic and pain patients often overlap. See our orthopedic billing services.
Take a look at your pain management claims
Medical necessity denials, authorization delays and modifier problems are what hold up most interventional practices. If you recognize yours, tell us about it. A free billing audit is a good place to begin.
Get a Free Billing AuditCall (321) 788-3655Frequently Asked Questions
What pain practices ask us.
1. Do you handle prior authorization for epidurals and ablation?
Yes. We look up each payer's requirement, submit the request and follow it to approval. Codes, levels and dates on the claim are matched to it.
2. How do you deal with medical necessity for injections?
We check documentation against payer and Medicare coverage policies before billing, and tell your team when a diagnosis, prior treatment or diagnostic block result is missing.
3. Can you bill spinal cord stimulators and pumps?
Yes. We follow the staged procedure, device and place of service rules that apply.
4. Do you bill urine drug testing?
Yes. We follow payer rules for the level of testing and the medical necessity documentation.
5. Will we need to change our EHR?
No. We work in your current EHR and billing software with secure access.
Neighboring specialties
Pain practices often share patients with these.
Orthopedics Billing
Musculoskeletal surgery and care that overlaps with pain work.
Physical Therapy Billing
Rehab visits that follow procedures, with their own timing rules.
Multi-Specialty Billing
A pain department inside a larger group.