Pain Management Billing Services

For spinal injections, payers rarely question whether a procedure exists; they question whether this patient qualified for it this time. Medicare contractors' facet joint coverage policies, for example, require two diagnostic medial branch blocks with significant relief before radiofrequency ablation is covered, and limit how often treatments can be repeated. Commercial policies tend to follow a similar logic with their own thresholds.

Imaging is the next trap. Many spine injection codes include fluoroscopic or CT guidance in their descriptors, and NCCI states that guidance codes such as 77003 are not reported separately with the epidural codes that include it. Level, side and bilateral reporting vary by code family too.

Pain practices that manage long-term medication also bill urine drug testing, which has its own code structure and its own medical necessity rules. Coverage policies treat blanket orders, the same tests ordered for every patient, as not reasonable and necessary.

Spinal cord stimulator trials and permanent implants carry the heaviest documentation load in pain management. Medicare's national coverage policy, for example, requires psychological screening, a documented failure of other treatments and a successful trial before the permanent implant. The trial and the implant are separate authorizations, often with the facility, the surgeon and the device on different claims.

Because these cases involve several parties, we confirm who is billing what before the procedure: the professional service, the facility fee and, where it applies, the device. That avoids the duplicate and missing claims that are common with implant procedures.