Coding and billing is a tricky part of ASC business, as it requires deep, thorough knowledge and great attention to detail. Laxmaiah Manchikanti, MD, chairman of the board and CEO of the American Society of Interventional Pain Physicians and medical director of the Pain Management Center of Paducah (Ky.) and Ambulatory Surgery Center in Paducah, explains one aspect of coding that is often overlooked at ASCs.
Q: What can ASCs do to ensure proper coding of these procedures and treatments?
LM: First, ASCs have to ensure they are meeting medical necessity criteria for each and every procedure. Each procedure has to stand on its own. Because of the significant growth in the pain management market, the important thing for ASCs to remember is meeting medical necessity criteria and indications. If you don't, you won't be properly reimbursed.
Many healthcare organizations are not aware of the medical necessity criteria. ASCs have to be extremely careful in meeting these criteria and documenting necessity and medication. Further, they also need to look at and follow correct coding initiative with comprehensive, component and mutually exclusive codes. Let's say, for example, in a hypothetical situation, a patient needed a facet joint block. Medical necessity requires patients not to have significant leg pain — only in their back and hips — and the pain has to get worse in hyperextension and there can be no disc herniation. So all these criteria need to be met before the pain management physician can perform the blocks. Most states are requiring two control blocks, and you have to report that there is a concordant relief, meaning the second block gives more relief than the first. If you don't document all these things and you move forward with radiofrequency, you will not get paid. And then there are also limitations on how frequently you can inject facet joint blocks.
Learn more about Ambulatory Surgery Center in Paducah.
Q: What can ASCs do to ensure proper coding of these procedures and treatments?
LM: First, ASCs have to ensure they are meeting medical necessity criteria for each and every procedure. Each procedure has to stand on its own. Because of the significant growth in the pain management market, the important thing for ASCs to remember is meeting medical necessity criteria and indications. If you don't, you won't be properly reimbursed.
Many healthcare organizations are not aware of the medical necessity criteria. ASCs have to be extremely careful in meeting these criteria and documenting necessity and medication. Further, they also need to look at and follow correct coding initiative with comprehensive, component and mutually exclusive codes. Let's say, for example, in a hypothetical situation, a patient needed a facet joint block. Medical necessity requires patients not to have significant leg pain — only in their back and hips — and the pain has to get worse in hyperextension and there can be no disc herniation. So all these criteria need to be met before the pain management physician can perform the blocks. Most states are requiring two control blocks, and you have to report that there is a concordant relief, meaning the second block gives more relief than the first. If you don't document all these things and you move forward with radiofrequency, you will not get paid. And then there are also limitations on how frequently you can inject facet joint blocks.
Learn more about Ambulatory Surgery Center in Paducah.