If your pain specialist decides that this treatment is suitable for your condition, a comprehensive trial is undertaken to determine if SCS will be helpful to you. Other conditions that may also respond to SCS include complex regional pain syndrome (CRPS), pain following nerve injury, refractory gain, post-herpetic neuralgia and peripheral vascular disease. It can also be used to treat back pain that is not suitable for spinal surgery. Spinal cord stimulation is most commonly used for leg, back and arm pain that has not responded to spinal surgery. A hand-held charger: some IPGs are rechargeable and require regular charging to maintain stimulation.A hand-held controller: this is used to turn the system on and off, adjust the type of stimulation, location of stimulation and level of stimulation.An electrode: this sits in the epidural space and delivers very small and precise currents to the spinal cord.It is implanted under the skin and has an inbuilt battery. Impulse Generator (IPG): this is a computer that is roughly the size of a matchbox that controls the impulses delivered to the spinal cord.As a result, the pain messages that your body sends to the brain are blocked or modified.Ī spinal cord stimulator system is made of four parts: Improvement in Practice Collections. Improved the average monthly collection of the practice from by 36% from $170K to $231 K.Spinal Cord Stimulation (SCS) alters the experience of pain by sending impulses to the spinal cord that compete with pain signals. 61-90, 91-120, and 121+ day buckets, to a quarter of the June 2017 numbers Keeping A/R Current. By September 2019, we reduced the A/R in the >60-day buckets, i.e. ~50% Reduction in Insurance A/R. Through consistent follow-up, root cause analysis of each denied claim, and systemically addressing each issue, we were able to reduce the overall Insurance A/R from $ 1.1 M to less than $ 600K in two years. It reduced the denials ratio tremendously in overall practice performance.Ĭleared A/R Backlog. We cleared all the denied/AR pending claims affected due to this issue and received a payment of around $90K. Resolved the Inclusive Procedure Denials. None of the claims are getting denied for procedure code 63650 as inclusive. Since the identification of the issue in Jun 2017, we were able to develop and institutionalize the solution by the beginning of 2018 using subsequent re-filing of the claimsįrom as many as 68 claims being denied in the second half of 2017, we were able to reduce the denied claims to 8 in the first half of 2018. In case, the Payer requests for additional information, medical records including operative reports, history of the condition, Psychiatric Evaluation notes should be provided to ensure that the medical necessity of the procedure is justified. We worked with the Physician’s office and educated them on the need to append modifier 76 to the second line item. Insurance reprocessed the claim and paid for the second unit of service. We identified this issue, reviewed detailed billing guidelines, and tried rebilling denied claims by appending modifier 76 only to the second line item. However, the Payer paid for one unit and denied the second unit as inclusive. The encounter was created by appending modifier “51 -multiple surgeries/procedures” on second line items or combination of modifier 51 & 76 on both line items, respectively. SolutionĪ few months after the successful transition of the processes to our offshore teams, we noticed that the claims relating to the Spinal Cord Stimulator procedure were getting consistently denied and started exploring for a solution. However, these coding guidelines were not well understood by the clinic’s in-house team. The guidelines mandate that the patient should undergo a Psychiatric Evaluation test to ascertain the medical necessity for the procedure. CMS established non-facility practice expense (PE) relative value units (RVUs) for CPT 63650 that are valued to include payment for the lead(s) and other practice expenses associated with office-based trials. As a specialized pain management clinic, the provider saw a high rate of denials on account of these specific eligibility requirements. The physician will consider this procedure only when the patient is continuing to suffer from chronic pain even after other treatments such as medication and physiotherapy. Spinal Cord Stimulator is a high-dollar value procedure in Pain Management. Each needle should be considered as one unit, and each unit needs to be billed as a separate line item along with a supportive modifier to get both units paid. Billed using the CPT code 63650, the procedure involves the insertion of two needles into Spinal Epidural Space.
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