Author Topic: Acceptable ICD-9 codes for pain management  (Read 3055 times)

thatcuteblonde

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Acceptable ICD-9 codes for pain management
« on: April 27, 2009, 08:40:39 AM »
I'm trying to find a list of acceptable ICD-9 codes that show medical necessity for pain management procedures such as CPT code 64445 but have been unable to find the Medicare LCD for these. I've tried Googling it but to no avail. Any suggestions on where I might find some useful documentation on which codes to use?? Our M.D. has some real issues with linking appropriate diagnosis codes, for example she listed Anxiety and depression as the primary and secondary codes for an NCV billed to Medicare, even though that was not the reason for the test. I'm hoping to find something to help her but have come up empty handed. ???

PMRNC

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Re: Acceptable ICD-9 codes for pain management
« Reply #1 on: April 27, 2009, 03:42:29 PM »
Quote
Any suggestions on where I might find some useful documentation on which codes to use?

One thing you don't want to do is bill a visit using an ICD9 or Procedure Code based on whether it's covered or not. Coding of charges should be coming from the patient's chart. It would be better to educate the provider in proper coding (order of Codes, modifiers, etc) OR have an experienced coder do it.
The Coding Institute has a great yearly newsletter on Pain Management Coding you might find helpful. http://www.codinginstitute.com/

Linda Walker
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thatcuteblonde

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Re: Acceptable ICD-9 codes for pain management
« Reply #2 on: April 29, 2009, 08:29:55 AM »
I know that, but my question is UHC has denied every 64405 that we bill and won't give any specific info on this when I call for benes. At this point we're contemplating making all UHC patients cash for this service but would like to know if they cover it under any circumstances before doing so.

For example, Medicare has their LCD's which indicate which ICD-9 codes are approved for which CPT code. Having this information doesn't indicate that one should falsely code a claim or advocate such a thing, it does however let you know which services will be covered based on the patient's condition, which is all that I'm trying to find out for UHC.

Has anyone had any experience with this?? If the Medicare LCD shows that this service is considered Medically Necessary for neuralgia or migranes, then it gives us information that would be helpful when composing our appeal and if UHC won't cover this service regardless of the condition, we know not to accept the patient's insurance for this service.

PMRNC

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Re: Acceptable ICD-9 codes for pain management
« Reply #3 on: April 29, 2009, 10:55:40 AM »
IF UHC is denying as non covered or not medically necessary you can bill the patient the full charge. As a courtesy your office could inform the patient that their insurance may or may not cover the services for certain conditions. I am curious as to why UHC won't tell you what criteria has to be met for the service to be covered.

I found this ..maybe it will help, it is from 2008 and Florida Medicare but it has the LCD's for CPT 64405 in it.
 http://www.med.miami.edu/ummg/documents/Newsletter%20October%202008.doc

Linda Walker
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Linda Walker
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Michele

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Re: Acceptable ICD-9 codes for pain management
« Reply #4 on: April 29, 2009, 08:55:17 PM »
I'm not aware of UHC ever putting out anything like the LCD's that advise you what dx's are covered.  I hope that the link that Linda provided is helpful.

Thanks Linda!

Michele
 
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