Reimbursement for Pain Management in the Coming Years | Hospital Outpatient Coding CPC-H Certification

At the 12th Annual Spine, Orthopedic and Pain Management Driven ASC Conference in Chicago on June 13, Amy Mowles, president and CEO of Mowles Medical Practice Management, spoke about reimbursement for pain management in the coming years.

Ms. Mowles began the presentation by comparing reimbursement for certain pain management procedures over the years. She started with sacroiliac joint injections, which have really seen a decrease in reimbursement.

From 2000 through 2005, the average office rate payment for an SI joint injection was $480. From 2006 through 2011, that rate fell to roughly $200. Part of the issue here is that physicians were learning how to perform the procedure from one another via telecast and other informal communication methods rather than licensed, approved educational forums.

That’s still happening today, said Ms. Mowles. “What you will find, thank goodness, is insurance companies are starting to ask: ‘If you want to be a participating provider in our network, where did you learn to do SI joint injections?'”

Reimbursement for SI joint injections really fell from 2012 through the present, though. Payments now average $170, said Ms. Mowles.

Speaking of the present, Ms. Mowles said CMS’ cuts for pain reimbursement in 2014 were drastic. “They are saying pain is overutilized, and it is,” she said. “There is a lot of money being spent in pain management.”

She emphasized the need for education about pain management, and how clinicians should not approach these procedures as quick nor easy. “From what I’ve seen, that simply is not true,” she said. “I do not take it lightly at all.” She also said an official from one state health department told her pain management was “provocative and invasive,” and he questioned the validity of its provision in the ambulatory or outpatient setting.

Ms. Mowles said she thinks states will have more authority if pain management continues to shift to “less sophisticated platforms.” State health departments will exercise more jurisdiction about what can safely be done in their states. She advised stakeholders to stay informed, get involved and understand what Medicare is planning next and how it will affect their bottom lines. Any ASC with adequate pain management procedure volume that is enough to keep providers and staff productive and equipment busy will be profitable, Ms. Mowles noted in her presentation.