Interventional pain management: evolving issues for 2003

The new millennium has seen the introduction of an array of new Current Procedural Terminology(R) (CPT) codes and the expansion of interventional techniques. Among the many issues of interest to physicians practicing interventional pain management in 2003 are CPT coding, correct coding issues, and utilization. The CPT developed and updated by the American Medical Association, is the most important and commonly used coding system for interventional pain physicians in the United States. A recent development in the CPT system has been to include Category I, Category II, and Category III CPT codes. Inclusion of a code in Category I is generally based on the procedure being consistent with contemporary medical practice and being performed by many physicians in clinical practice in multiple locations. In contrast, CPT Category III, also known as emerging technology codes, is a set of temporary codes for emerging technology, services, and procedures. There have been many new codes since 2000, along with changes in the definitions of the codes and vignettes. In order for the correct coding initiative to be effective, it is essential that the coding describes what actually transpires at each patient encounter. When multiple procedures are performed at the same session, the procedure and post-procedure work do not have to be repeated for each procedure, and, therefore, a comprehensive code describing the multiple services commonly performed together can be used. Thus, many activities which are integral to a procedure are considered as generic activities and are assumed to be included as acceptable medical/surgical practice and, while they couldn't be performed separately, they should not be considered as such when a code narrative is defined. Under this initiative, almost all interventional techniques are affected. The utilization of interventional techniques in the modern era is the final issue. Utilization has been increasing gradually. Thus, it is important for interventional pain physicians to understand the utilization patterns across the nation and for various techniques. This review will discuss the issues of CPT coding, correct coding, and utilization as they pertain to interventional techniques.