Appropriate documentation, billing and coding in interventional pain practice

Abstract

Appropriate documentation, billing and coding in interventional pain practice is a crucial issue with a wide arena of regulatory reforms. There have been reports of billions of dollars in losses in health care fraud. Office of Inspector General reports a massive war on health fraud. Substantial savings from prepayment audits for Part B in 1999, and continued criminal filings by the Department of Justice indicate persistence of Health Care Financing Administration to combat fraud. In addition President Clinton's initiatives to fight Medicare waste, fraud, and abuse have created increased fear of investigation or prosecution among physicians, leading to changes in their practice patterns. Documentation of medical necessity with coding that correlates with multiple components of the patient's medical record, operative report, and billing statement is important. This review describes the regulatory issues, steps in documentation of medical necessity, appropriate billing and coding, and examples of codes describing CPT 1999 and 2000 for a multitude of procedures. These illustrations and the information provide practical considerations for the use of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management, rules and regulations. However, this article and its descriptions do not constitute legal advice.