Health Information Management

New 2014 CPT codes for pain management treatment and care

APCs Insider, October 18, 2013

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Helping patients who are suffering is a foundational element of every healthcare professional’s ethical obligation. When a patient is in pain, providers have many options for alleviating this situation.

The AMA added new codes to the 2014 CPT® Manual to enable professional coding specialists the opportunity to accurately report the provision of services and treatments.
 
Chemodenervation
The use of botulinum toxin, atropine, and other pharmacologic compounds in the treatment of various types of pain generate considerable discussion. The chemical is injected directly into a neural structure or muscle to paralyze it and reduce its ability to generate the sensation of pain. 
Botulinum toxin has been approved for the treatment of spasticity, as well as pain management for conditions that include migraines and muscle pain. This chemical originated with the bacterium known as Clostridium botulinum and attaches to nerve cells—particularly those that lead to muscles—blocking their communication to the brain. This chemical stops the neurotransmitter acetylcholine from being released. Acetylcholine is the body’s chemical that causes muscles to contract. 
Atropine (the generic name) blocks the muscarinic receptor, the main end-receptors that are stimulated by the release of acetylcholine in the parasympathetic nervous system—specifically at the parasympathetic sites within smooth muscles, secretory glands, and throughout the central nervous system. 
The 2014 CPT Manual expands this sub-section, providing additional codes for more specific reporting of the procedure. 
One example is for patients suffering from spasmodic torticollis, a neurological movement disorder that causes the neck to turn involuntarily sideways, downwards, and/or upwards, causing acute pain. 
When the physician provides chemodeneravation treatment to the patient’s neck muscles, coders would report a new code for 2014—64616 (chemodenervation of muscle[s]; neck muscle[s], excluding muscles of the larynx, unilateral [e.g., for cervical dystonia, spasmodic torticollis[). Code 64616 will replace code 64613 (chemodenervation of muscle[s]; neck muscle [s] [eg, for spasmodic torticollis, spasmodic dysphonia]). 
Providers can use chemodenveration to treat painful muscle contractions in the trunk, such as those caused by:
  • Tetanus
  • Latrodectism (black widow spider bite),
  • Abdominal rigidity (acute, involuntary contractions of the rectus abdominus, and internal and external oblique muscles 
These procedures will be reported with one of two new 2014 CPT codes replacing code 64614 (Chemodenervation of muscle[s]; extremity and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]):
  • 64646, chemodenervation of trunk muscle(s); 1-5 muscle(s)
  • 64647, chemodenervation of trunk muscles; 6 or more muscles
Recent research has indicated that physicians can effectively treat pain response for conditions—such as tennis elbow—with chemodenervation. 
Report chemodenervation treatments of the extremities with one of four new 2014 CPT codes:
  • 64642, chemodenervation of one extremity; 1-4 muscle(s)
  • +64643, each additional extremity, 1-4 muscle(s)
  • 64644, chemodenervation of one extremity; 5 or more muscle(s)
  • +64645, each additional extremity, 5 or more muscles 
New evaluation and management codes
A physician, especially one who is not a neurologic specialist, commonly initiates an interprofessional consultation when a patient is suffering with acute/chronic pain and is needs immediate relief. 
In these cases, it may not be realistic to wait for the opportunity to meet face-to-face, and therefore, the physician-to-physician (or other healthcare professional) consultation occurs via telephone or the Internet. These new codes may not be reported when a transfer of care has occurred, is expected, or is planned.
The new codes for 2014 are:
 
  • 99446, interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
  • 99447, interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 11-20 minutes of medical consultative discussion and review
  • 99448, interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 21-30 minutes of medical consultative discussion and review
  • 99449, interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 31 minutes or more of medical consultative discussion and review 
Coders will use the length of time the consultative discussion lasted to select the correct code.
New Category II codes
Physicians reporting Category II code will find a few new 2014 codes related to pain management, especially for those patients with neuropathy (a painful disorder of the sensory nerves with results in hypersensitivity to tactile stimuli). 
Neuropathy is a common manifestation of diabetes mellitus.
 
The new Category II codes are:
  • 1500F, symptoms and signs of distal symmetric polyneuropathy reviewed and documented
  • 1520F, patient queried about pain and pain interference with function using a valid and reliable instrument
  • 3751F, electrodiagnostic studies for distal symmetric polyneuropathy conducted (or requested), documented, and reviewed within 6 months of initial evaluation for condition
  • 3752F, electrodiagnostic studies for distal symmetric polyneuropathy not conducted (or requested), documented, and reviewed within 6 months of initial evaluation for condition
  • 3753F, patient has clear clinical symptoms and signs that are highly suggestive of neuropathy and cannot be attributed to another condition and has an obvious cause for the neuropathy 
These new CPT codes, effective January 1, 2014, will help professional coding specialists continue to report procedures, services, and treatments in the most accurate manner possible.
 
Editor’s note: Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, of Safian Communications Services in Orlando, Fla., answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee. Email her at ssafian@embarqmail.com.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • Medical Records Briefing

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular