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INTRODUCTION

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Multiple issues related to documentation, billing, and coding are facts of life for physicians practicing interventional pain management. Emphasis continues on the description and definition of what the physician does for and to the patient. Various issues related to billing and coding in interventional pain management requires understanding of procedural coding systems, diagnostic coding systems, and appropriate documentation for interventional techniques and other services provided by physicians. Consequently, documentation of medical services is necessary to provide information, which is medically necessary and indicated, to assist health care professionals in providing services to patients. Furthermore, appropriate documentation, billing, and coding also reflect the competence and character of the physician while assisting in the financial survival.

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DIAGNOSTIC CODING SYSTEMS

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The medical necessity for any physician or provider encounter requires appropriate diagnosis and coding by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to justify services rendered and to indicate the severity of a patient’s condition.1,2 Coding should be completed to the highest degree of certainty for each encounter. Coding also should correlate with multiple components of a patient’s medical record, including initial evaluation or follow-up visits and the billing statement.

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The ICD-9-CM is a coding system used to report patient illnesses, injuries, complaints, or symptoms, termed diagnoses.2 The ICD-9-CM communicates to third-party payers—the need for medical services or why a physician performed a service. The ICD-9-CM system consists of code numbers and narrative descriptions similar to those found in the Current Procedural Terminology (CPT), even though the two systems are distinctly separate and different.

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In addition to the ICD-9-CM diagnostic coding systems, other diagnostic coding systems are also available. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), for psychiatric and mental health services is one such system.3 The International Association for the Study of Pain (IASP) also has published a diagnostic classification of pain disorders, a coding system entirely different from the ICD-9-CM and the DSM-IV.4

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Subsequent to ICD-9, ICD-10, the 10th revision has been introduced for coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as classified by the World Health Organization (WHO).5 While the United States is considering its application, approximately 25 countries already use ICD-10 for reimbursement and resource allocation in their health systems. The United States will begin official use of ICD-10 on October 1, 2013, using clinical modification of ICD-10-CM for diagnosis coding and procedure coding and ICD-10-PCS for inpatient hospital procedure coding.5

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PROCEDURAL CODING SYSTEMS

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Procedural coding systems communicate the procedures and services provided to patients and the reasons they were provided. It is required for physicians to understand procedural coding systems not only for proper reimbursement and for appropriate record keeping, but also to avoid fraud and abuse implications. The advent ...

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