Chronic pain affects more than 50.2 million Americans, making the CPM bundled payment an essential and timely intervention. With this payment, patients can benefit from a comprehensive, person-centered plan of care that includes diagnosis, care coordination, medication management, and other elements of integrated, multimodal pain care.
The Centers for Medicare & Medicaid Services (CMS) continuously strives to give more people access to evidence-based treatments for acute and chronic pain and enhance the care experience for people with pain.
We’ll discuss the 2023 CMS Pain Management Codes list with you in this article.
The Centers for Medicare & Medicaid Services (CMS) Pain Management Codes for 2023
The start of a new year is exciting. However, you must know the latest CMS CPT codes as a pain management provider. That is why the CMS rolled out new chronic pain management codes, including bundled care, evaluation and management, telecare visits, and more.
Stay current on the latest CMS CPT codes for your pain management practice to ensure you receive the proper reimbursement.
New CMS Codes for “Bundled” Care
As a pain management provider, you don’t have to worry about billing or coding services separately. You can now use the 2023 CMS chronic care management codes to report on the monthly care you provide. This process makes billing for these services easier since specialists can now report the bundled code monthly. To make sure you have an understanding of what is included in the Chronic Pain Management coding (CPM) bundle, be sure to review the code descriptor.
Code Descriptors for the New Chronic Pain Management CPT Codes
HCPCS Code G3002
Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. Required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified healthcare professional, per calendar month. (When using G3002, 30 minutes must be met or exceeded.)
HCPCS Code G3003
Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified healthcare professional, per calendar month (List separately in addition to code for G3002). (When using G3003, 15 minutes must be met or exceeded.)
The HCPCS code G3002 describes assessing, diagnosing, and monitoring a patient’s pain, combined with their treatment and coordination with other clinicians.
Take Note: This HCPCS code only describes the first 30 minutes of chronic pain management services.
If you spend over 30 minutes on CPM with the patient, you can report the new add-on code G3003.
Definition of Chronic Pain
Physicians have long encountered difficulties providing evidence to Medicare payers for “chronic” conditions because the agency does not specify its interpretation. Currently, CMS defines chronic pain as “persistent or recurrent discomfort lasting more than three months.” Despite this definition, some providers may believe CPM codes cover only existing patients.
The Fee Schedule states specifically:
The beneficiary, at the first visit, need not have an established history or diagnosis of chronic pain or be diagnosed with the condition that causes or involves chronic pain; rather, it is the clinician’s responsibility to establish, confirm, or reject a chronic pain and/or pain-related diagnosis when the beneficiary first presents for care and the clinician is using HCPCS code G3002.
CMS 2023 E/M Changes
It is now possible to report evaluation and management (E/M) visits (99202-99215 in the office setting) along with CPM codes as long as the documentation indicates that an E/M visit was performed separately from the time documented for the CPM visit. Anyone who reviews the patient records should be able to identify the E/M documentation from the CPM note. Moreover, both should stand on their own regarding the time spent and the information covered.
Updates on Telehealth
CMS has added CPM to its list of telehealth services, with one significant stipulation: the initial visit must be in person. Afterward, the patient can present through telehealth for subsequent visits.
Due to the lifting of COVID-19 regulations, telehealth regulations may change in the near future. Keeping track of any extensions to the PHE expiration date is also necessary.
If you’re looking for additional information, please check out the CMS Website.
CMS Additional Regulations and Requirements for Billing the Chronic Pain Management Codes.
The billing for pain management codes must match the service described in the code descriptors. Check out the additional CMS guidelines for 2023 below:
Auxiliary personnel may not provide services incident to a physician’s (or other QHP) professional duties.
During the initial visit, the beneficiary must provide verbal consent, and it must be recorded in the beneficiary’s medical records. There is a need to educate beneficiaries on what CPM stands for, how often they may expect to receive the services, and what cost-sharing may be relevant to their circumstances.
CPM services may be billed on the same date as E/M services. Moreover, these services can be billed in the same month as remote physiologic monitoring (RPM) services, remote therapeutic monitoring (RTM) services, and care management services (such as chronic care management (CCM), transitional care management (TCM), or behavioral health integration (BHI) services), if all the criteria for reporting each service is fulfilled. Nevertheless, the time spent providing CPM services cannot be counted as time for any other service that has been provided and billed.
The HCPCS code G3002 may be billed by an unlimited number of physicians for a beneficiary for a month, if medically necessary. G3003 can be billed multiple times for a particular beneficiary and month, if medically necessary, once G3002 has already been billed. Despite this, CMS will monitor utilization.
The scope of CPM services is limited to outpatient and home care settings.
Summary of Chronic Pain Management Codes
The Centers for Medicare & Medicaid Services (CMS) created a new code set to reimburse providers for treating chronic pain patients. It’s also good that CMS acknowledges the significance of care management services in improving patient outcomes and reducing healthcare costs.
Note: HCPCS codes describe drugs, supplies, and other services not included in CPT codes. Furthermore, CPT and HCPCS codes have 5 characters, but HCPCS begins with a letter, and the rest are numbers. CMS administers HCPCS codes, not the AMA.
Change is inevitable in healthcare. Providers are seeking ways to streamline medical billing and coding. Therefore, advanced technology is vital to achieving optimum efficiency in coding and billing processes.
Pain Management Crisis
Chronic pain is a colossal public health issue. It costs billions of dollars in lost productivity and creates major health problems. According to the Centers for Disease Control (CDC), more than 50 million U.S adults suffer from chronic pain or one in five adults. As incidents of long-term arthritis and age-related conditions go up, this number will continue to rise. There will be more demand for pain medicine in the future. Additionally, payer demands are becoming a hassle. Prior authorization requirements put pain management at risk, affect fee schedules, and require patients to shoulder financial responsibility.
How to Optimize Coding and Billing in Pain Management Practices
Utilizing the latest technology in revenue cycle management allows your practice to get paid for work in a timely and efficient manner. In pain management, coding and billing solutions are readily available to help your practice. We will explore the latest solutions that help optimize pain management medical billing and coding:
Outsourcing
Medical practices know that medical billing is a vital but demanding task. Revenue cycle tasks such as patient scheduling, insurance verification, claims management, AR follow-ups, and payment collection can be challenging. When revenue is at stake, the quality of patient care goes down. That’s why many healthcare providers in pain management consider medical billing outsourcing.
Outsourcing billing and coding allows practices to:
Achieve a flexible schedule for staff.
Maintain continuity and manage risks.
Boost growth.
Manage the basic tasks efficiently.
Ensure operational control.
Make sure reimbursements are prompt.
Reduce expenditures.
Increase productivity.
Cut revenue leaks.
Balance AR (account receivables)
Outsourcing is an effective way for medical practices to grow and expand while minimizing costs. Indeed, the best pain management billing company will help you ensure profitable revenue.
Automation of coding and billing
Automation is the future of medical billing and coding. Software automation can assist healthcare providers in cutting down unnecessary expenditures. Furthermore, it eliminates time-consuming tasks.. Billing automation can also bring considerable benefits to insurance pre-authorization. Moreover, the process of verifying eligibility and payment limits is simplified.. Thus, patients can get immediate care as soon as they need it.
Accurate pain management coding
Pain management coding always must be accurate. It’s the first step towards optimizing your healthcare revenue cycle management. A correct coding initiative is essential from a compliance standpoint. It is also helpful for reducing rejections, claim denials and ensures optimum reimbursements. Claims must be error-free and precise before they are sent out.
Here are coding initiatives that will increase collection and reduce denials:
Hire coding specialists for accuracy and efficiency. Partnering with a certified medical coder that focuses on pain management practices can quickly improve your cash flow.
Avoid non-specific diagnoses codes. In comparison with ICD 9, ICD 10 documentation requirements are much more detailed.
Avoid incorrect modifier usage.Make sure your coding follows payer-specific guidelines so that you don’t face denials or underpayments.
Avoid using a higher-paying code on a claim to receive big reimbursements. This refers to upcoding. This issue can cause more claim denials.
Stop upcoding and unbundling, as both are illegal. Unbundling involves submitting bills piecemeal to maximize the reimbursement for tests and procedures that require billing together.
Stay away from under-coding – omitting or exchanging codes for a lower level of codes or less expensive code is leaving money on the table.
The medical necessity needs more documentation.
Switching to Telehealth
The concept of a virtual visit is an interaction between patient and provider that doesn’t take place in the same room. It is also becoming more common in health care. For medical practitioners, virtual visits affect medical billing. The new CPT codes reflected the billing and procedures changes, so insurers had to update their policies right away. COVID-19 prompted many new treatments and protocols, which resulted in modifications to coding and billing. Health care providers lost a lot of money in the transition period due to denied claims. That’s why pain management billing software for your practice helps incorporate these changes. In addition, it prevents revenue leaks and ensures maximum future compatibility.
New Software for Revenue Cycle Management (RCM)
What is Revenue Cycle Management software? It helps physicians and healthcare providers track and manage revenue from a patient’s lifecycle. Revenue cycle management solutions augment medical billing software functionality. It includes:
Seamless integration with EHR/EMR software – an easier way for exchanging data with the billing system.
Insurance eligibility and pre-authorization toolsensure the revenue collection process starts on the right path.
Advanced A/R management enables you to assist your facility’s staff and patients with the payment process.
Clearinghouse – an in-house intermediary service reduces the time spent on the remittance process.
More important than ever, these features support financial operations throughout the life cycle of a medical facility.
Tap Into Our Expertise
It’s crucial to rely on current medical coding and billing solutions in light of these changes. These processes can further enhance your— billing processes, revenue cycle, and pain management practice.
At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.
Maintaining a profitable practice means ensuring a healthy revenue cycle for any pain management practice. However, pain management practices still encounter hardships due to their complexities in billing and coding. It can be challenging to manage the processes when it involves stakeholders and obtaining payment relies on consistent interactions. Keeping departmental and payer communications open can help keep accurate information sorted and categorized throughout the process. The following are the most common billing and revenue cycle issues in Pain Management Practices:
A manual process on claims denial management
Using a manual process for managing denials can slow down your cash flow. At the same time, it can still lead to more inaccuracies and errors.
According to Michelle Tohill, Director of Revenue Cycle Management at Bonafide Management System, healthcare providers should switch to automated systems to avoid denials. In addition, staying on top of diagnostic codes and different insurance policies can be exhausting. However, many software providers will automatically update requirements and coding procedures.
She also added that there are still many software providers who are constantly updating codes and requirements. In this way, your billing staff can double-check claims. Making sure they meet the demands and saving research time.
Furthermore, your staff needs to be aware of future happenings to get reimbursements, less time figuring things out, and detect necessary parties.
Automating claim denial management in medical billing can help providers identify errors before submitting claims.
There may still be difficulties toward submitting claims and associated labors in managing denials, stated Brendan FitzGerald, HIMSS Analytics Director of Research. Surprisingly, software providers have not automated the denial management process through a vendor-provided solution.
If managing denials are a lot, productivity might be slow through a manual process.
Denial management is still a question, whether it is outsourcing or in-house. The HIMSS study found that 44% of healthcare professionals preferred outsourcing such as revenue cycle management, clearinghouses, or EHRs, while 18% implemented an automated system in-house.
Medical billing teams from denial management draw data over healthcare industries and handle multiple payer rules and codes.
Coding Errors
Incorrect codes will lead to deferred, denied, or half-paid claims. Pain management practices continue to struggle with the complexities of codes for pain management coding procedures. These are the top coding issues:
Inaccurate coding on clinical coverage
Improper procedural codes
Out-of-date codes
These can bring about mistakes that become costly to your pain management practice. On the other hand, money is not always an issue. It can also lead to legal consequences like:
Imprisonment – for penalties and false claims submitted per file
Clinical Maltreatment – If there’s proof of deliberate distortion throughout quite a while and across countless patients.
Even though these may seem alarming, the most well-known result of billing issues is that insurance agencies will not reimburse your cases.
Prior Authorization Delays
Prior Authorization (PA) setbacks can deprive physicians of time in catering to patients and increase their expenditures. Some medical insurance companies require prior authorizations (PA) before providing pain management procedures. It serves as a significant barrier for physicians to deliver quality care. PA helps with:
Monitoring healthcare costs
Proper approval from patients plan
Providing payers with a secure prescription for medicine and drugs
Despite this, the process can slow down the delivery of needed services and care for patients. To improve PA performance, physicians adopt the usage of Pain Management EMR Software. Electronic Prior Authorization integrates directly with your electronic medical records (EMRs). Healthcare professionals can use it to obtain prior authorization in real-time. Additionally, it eliminates the need for time-consuming paper forms, faxes, and telephone calls.
No proper staff training
Unskilled staff in the healthcare industry might cause revenue cycle management issues. In relation, they might not bill or capture patient data correctly. Proper staff training is necessary to capture patient’s demographic information on the front end. Also, on how to translate that data to successful insurance claims after that. With that, patient schedules and registrations must also be accurate to avoid problems in revenue. Conducting staff training might be time-consuming, but it is worthwhile. It can increase cash flow well after, although it might also be costly. Moreover, your pain management practice will boost these areas:
Enhance job proficiency
Boost staff self-esteem
Employees will stay longer to your business
If you also think of outsourcing your revenue cycle management, talk to a Pain Management Billing specialist. Working with them can save you time and resources.
Failure to follow up on Accounts Receivable (A/R)
A/R follow-up process can be a handful at most times. The team assigned for this is to consistently handle interactions with patients, healthcare providers, and insurance agencies. There are also processes that your team needs to complete:
Verification,
Charge entry
Payment posting
Medical billing specialists regulate the precise diagnosis and exact procedure codes based on the treatment plan. If your A/R team has issues regarding this, your practice might be at stake. Your practice cannot establish good revenue without a proper A/R process. Without it, it can lead to high collections of A/R, and backlogs will occur. The worse thing is that insurance companies will deny claims if your A/R team fails these processes. If you want to increase your profitability, you can read these 8 Tips in Pain Management Practice.
Tap Into Our Expertise
These are just some of the common problems associated with pain management practices. Think about outsourcing your revenue cycle management to trained and experienced medical billers and coders. Having people take charge of your medical practice problems and provide solutions is always a great idea to boost revenue.
At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.
