Interventional Pain Management Procedures Interests the OIG
(Office of the Inspector General) for Review as Part of their 2008
Work Plan.

Interventional Pain Management Procedures Interests the OIG (Office of the
Inspector General) for Review as Part of their 2008 Work Plan.

     Let’s look at this why:

     Interventional Pain Management is a new and fast growing medical specialty.
     Their procedures consist of very minimal invasive procedures such as needle
     placement, injections of medications and drugs in targeted areas, joints, and
     spinal levels. They administer and perform facet nerve blocks, ablation,
     destruction, epidural and other surgical techniques. Interventional Pain
     Management providers believe these techniques can help them diagnose and
     treat chronic localized pain that do not respond well to other treatments such as
     for back pain. Section 1862(a)(1)(A) of the Social Security Act allows Medicare
     to pay for Pain Management Procedures that are Medically Necessary.

     In 2005 alone, Medicare paid nearly $2 billion dollars for Interventional Pain
     Management procedures. Now, the OIG, as part of their 2008 Work Plan will
     review and determine the appropriateness of Medicare payments made for  
     interventional pain procedures and estimate the oversights of these procedures.

     Educate your Practice and your Physician:

     There are local coverage determination (or they call it LCDs) that you need to
     understand – check with your local Medicare carrier. It contains utilization
     guidelines and policies that you need to be aware of if you are providing
     interventional pain procedures to Medicare beneficiaries.

     The LCDs will tell you about the utilization guidelines and policies. Such as how
     many services can you perform these procedures on the patient. Diagnosis
     codes that supports medical necessity.

     In New Jersey and New York Part B for instance, it is not medically necessary
     to perform facet joint nerve block injections on more than two spinal levels to a
     patient on the same day.  If it exceeds eight FJNB services -  4 bilateral, 8
     unilateral or a combination for CPT codes 64470, 64472, 64475 and 64476 by
     the same or any provider within 180 days will also be denied. You do not count
     the number of injections but bill and code the number of spinal level!

     It is essential to your practice that you have to be aware of the Local Coverage
     Determination documents provided to you by your local carrier. Always refer to
     your CPT book.


     Read more on 2008 OIG Work Plan
     ***** Search the LCDs & NCDs
     ***** Always refer to your Coding Books!
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