Pain Management Coding: Avoid Massive Penalties


No, you’re not paranoid. Your pain management claims ARE being watched. Why? Well, in 2017 CMS projected paying $165,931,356 in error for pain management services, and they are looking to get their money back.

So, if you submit claims for your pain management services to either Medicare or private payers, the importance of accuracy just shot through the roof. Not only is this the only way you’ll be paid correctly for the pain management services you provide, but it could also keep you off Medicare’s audit target list and stop you from having to pay hundreds of thousands in penalties and fines.

Don’t assume that your pain management claims are coded as accurately as possible just because you’re being paid. If you do that you are just waiting to be targeted. Instead, let expert coder and educator, Catrena Smith CCS, CCS-P, CPC, CPCO, CPC, CIC, CPC-I, CRC, CHTS-PW, help. During her 60-minute online training, she’ll walk you through how to more accurately code the pain management services you provide. She’ll also help you identify your highest risk areas so you can have a better chance of heading off a Medicare audit.

Here are just a couple of the plain-English, practical, how-to pain management coding tactics you’ll receive by viewing this 60-minute online training:

  • Master 2018 CPT code changes for peripheral neurostimulator services
  • Uncover proven urine drug testing documentation strategies to avoid audit flags
  • Improve modifiers 50, RT and LT accuracy application accuracy and reduced denied claims
  • Identify hidden errors in your injection/guidance combo claims that will get you audited
  • Head off ICD-10-CM coding errors with proven implementation strategies for new 2018 codes
  • Cut denials and speed payments for your epidural pain management claims
  • Avoid base unit discrepancies with proven, step-by-step tactics
  • And so much more…

Practices offering pain management services, are feeling the pain themselves. Audit findings are leading to massive penalties and fines, here are just 2 examples of pain management judgements posted on the OIG website:

  1. Inappropriate use of modifiers 76, 59, and QW = $1,577,597 fines
  2. Incorrectly submitting in-office urine testing claims = $590,763.45 in penalties

It’s easy to think that getting chosen for an audit, and being requested to pay hundreds of thousands of dollars in penalties will never happen to you – but don’t make this mistake. Medicare is under an obligation to Congress to reclaim the funds that they’ve over paid, and with pain management overpayment numbers equaling $166 million, you can bet that audits are only going to increase.

Don’t wait. Get the help you need to improve the accuracy of your pain management claims, and to head off Medicare and private payer audits. Register for this online training today.

Meet Your Expert

Catrena Smith
CCS, CCS-P, CHTS-PW, CPC-I, CPCPresident, Access Quality Coding & Consulting

With over 17 years’ experience in the Health Information Management Industry, Catrena is a nationally recognized speaker and has published numerous articles in professional journals and magazines. She has served in many roles such as coding specialist, coding auditor, coding trainer, medical records technician, and coding manager.

She is a former AAPC Local Chapter President, serves as a HIM student/new graduate mentor for multiple organizations and has served as an Advisory Committee member of a local college for several years. Catrena prides herself in helping to grow the next generation of health information management professionals.


I enjoyed the speaker, informative.
Lauren Wilcox
Certified Coding Specialist CPC, Murfreesboro Medical Clinic Spine Joint and Pain Center
I enjoyed the targeted information, Greatly beneficial.
Valere Velez
Billing, LAGS