Brand new pain doctor - where can I be primed/learn about billing and coding?

[cameroncarter]

I know nothing 🙁

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[Ducttape]

you should be learning this in your fellowship.

request meeting with coders and billers to get the rudiments.

then make sure your attendings have meetings - or have set up for you to meet with private pain guys - to go over billing and coding.

 

[Agast]

you should be learning this in your fellowship.

request meeting with coders and billers to get the rudiments.

then make sure your attendings have meetings - or have set up for you to meet with private pain guys - to go over billing and coding.

Are fellowships teaching this? I didn’t get any of it. My attendings pretty much went straight from training to academia.

 

[deleted875186]

Read the entire AMA 2021 guidelines on E and M coding for office visits, you’ll learn everything you need for follow ups and new patient visits. In a sense it’s good, all office visit coding was changed in 2021 so your on the same playing field as everyone else.

I would also recommend looking up the Medicare LCD for facet injections and epidural injections and reading them, can also look up Evicore, AIM, etc, guidelines in pain injections, they have a big pdf going throughout every common pain injection. This will tell you the indications and requirements for injections (6 weeks PT, imaging correlating, failed oral NSAID, etc).

For cpt codes, can just google, or get ASRA coding app, or painsource website.

Look up the CMS RVU physician tool below, it will tell you medicare RVU values for any cpt code you bill for, so you’ll know what procedures actually pay.

Physician Fee Schedule Look-Up Tool | CMS

To start your search, go to the Medicare Physician Fee Schedule Look-up Tool .To read more about the MPFS search tool, go to the MLN® booklet, How to Use The Searchable Medicare Physician Fee Schedule Booklet (PDF) .

www.cms.gov

 

[cameroncarter]

Are fellowships teaching this? I didn’t get any of it. My attendings pretty much went straight from training to academia.

I got zero %
🙁

 

[Pain Applicant1]

If you're still in training call the hospital billing department and see if you can work with them for a few hours here and there. That's what I did during fellowship and it was probably some of the best education I received during that time. Befriend a few of them and get their numbers so you can keep in touch. I called them a few times once I graduated. Gingerly pressure your attendings to set up a lecture from the billing department so you can learn the basics. From my experience, nearly all academic providers know next to nothing about billing so be careful of what they themselves try to teach you.

If you have already graduated still give them a call and ask them if you can ask them a few questions. Just don't take advantage of it. If you're practicing and working late and the billing department is closed, just contact a hospital in an earlier time zone and let them know you're freshly graduated and have questions. Technically, you're not lying and they'll assume from one of their programs.

Once you have the basics down, do your own billing for a few months and follow every claim through from beginning to end. You may feel like sticking needles in your eyeballs while doing this but that's really the main way to understand how to fully process a claim. It'll make your life a lot easier later on and will increase your collection rate.

There are essentially three basic steps to billing.
1. Generating the claim (must know how to code and document correctly)
2. Posting the claim (must know how to interpret an EOB and how to post it correctly)
3. Following up on the claim (correcting the claim and resubmission if denied or billing the patient if the EOB dictates)

I say in the past #3 is what pushed me closest to quitting

 

[Doctodd]

here is my superbill.....it has the most common codes that you should know.

 

[redchyvak]

you should be learning this in your fellowship.

We had a brief lecture on billing and coding, but I don't think anything could adequately prepare us for billing and coding without going through it ourselves.

I bought a coding course through Skill Acquire that went through some of the most commonly used codes. It was a decent overview, but I am still doing a fair bit of googling on almost every patient.

 

[Pain Applicant1]

We had a brief lecture on billing and coding, but I don't think anything could adequately prepare us for billing and coding without going through it ourselves.

I bought a coding course through Skill Acquire that went through some of the most commonly used codes. It was a decent overview, but I am still doing a fair bit of googling on almost every patient.

Yes, you will have to use google quite a bit but it'll get easier as the days pass. What used to take me hours per week now only takes minutes. You'll learn the games the payers play to deny your claim and once you get this you'll be able to scrub and submit the claim correctly so their computer doesn't kick it back.

 

[myrandom2003]

Forget the actual diagnosis.

If you want to get procedures Approved with minimalIssue,

Use m47.812, m47.816 or m47.817 for facet procedures

M51.16/m54.16/m54.12 for epidurals

M48.062 for mild/Vertiflex/esi

And m96.1 or g90.52x for stim in lumbar

G89.4 and z79.891 for opioids plus any of the above

Icd10data.com will give you billable codes per Medicare

 

[deleted875186]

Forget the actual diagnosis.

If you want to get procedures Approved with minimalIssue,

Use m47.812, m47.816 or m47.817 for facet procedures

M51.16/m54.16/m54.12 for epidurals

M48.062 for mild/Vertiflex/esi

And m96.1 or g90.52x for stim in lumbar

G89.4 and z79.891 for opioids plus any of the above

Icd10data.com will give you billable codes per Medicare

It’s like I’m looking at my own clinic notes.

 

[redchyvak]

Forget the actual diagnosis.

If you want to get procedures Approved with minimalIssue,

Use m47.812, m47.816 or m47.817 for facet procedures

M51.16/m54.16/m54.12 for epidurals

M48.062 for mild/Vertiflex/esi

And m96.1 or g90.52x for stim in lumbar

G89.4 and z79.891 for opioids plus any of the above

Icd10data.com will give you billable codes per Medicare

Well. This was infinitely better than the webinar I paid $250 for.

 

[wysdoc]

I know nothing 🙁

Try your state’s medical society, they may have some billing/coding workshops for new practitioners