Targeted Drug Delivery for Chronic Pain and Cancer Pain ...

Targeted Drug Delivery for Chronic Pain

Commonly Billed Codes 2022

TARGETED DRUG DELIVERY

COMMONLY BILLED CODES

TABLE OF CONTENTS

ICD-10-CM Diagnosis Codes............................................................... 3 ICD-10-PCS Procedure Codes............................................................ 7 HCPCS II Device Codes (Non-Medicare).............................................. 8 Device C-Codes (Medicare)................................................................. 8 Device Edits (Medicare)....................................................................... 9 HCPCS II Drug Codes.......................................................................... 9 Physician Coding and Payment............................................................ 10 Hospital Outpatient Coding and Payment........................................... 13 Hospital Inpatient Coding and Payment Non-Cancer Pain................... 17 Hospital Inpatient Coding and Payment Cancer Pain........................... 20 ASC Coding and Payment.................................................................... 24

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TARGETED DRUG DELIVERY

COMMONLY BILLED CODES

Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules and regulations. The provider has the responsibility to determine medical necessity and to submit appropriate codes and charges for care provided. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other payers as to the correct form of billing or the amount that will be paid to providers of service. Please contact your Medicare contractor, other payers, reimbursement specialists and/or legal counsel for interpretation of coding, coverage and payment policies. This document provides assistance for FDA approved or cleared indications. Where reimbursement is sought for use of a product that may be inconsistent with, or not expressly specified in, the FDA cleared or approved labeling (eg, instructions for use, operator's manual or package insert), consult with your billing advisors or payers on handling such billing issues. Some payers may have policies that make it inappropriate to submit claims for such items or related service.

The following information is calculated per the footnotes included and does not take into effect Medicare payment reductions resulting from sequestration associated with the Budget Control Act of 2011. Sequestration reductions went into effect on April 1, 2013.

For questions please contact us at neuro.us.reimbursement@

ICD-10-CM1 Diagnosis Codes

Diagnosis codes are used by both physicians and hospitals to document the indication for the procedure.

Targeted Drug Delivery (TDD) is directed at managing chronic, intractable pain. Pain can be coded and sequenced several ways depending on the documentation and the nature of the encounter and the documentation. Pain codes from the G89 series are used as the principal diagnosis when the encounter is for pain control or pain management, rather than for management of the underlying condition. Additional codes may then be assigned to identify the underlying cause and give more detail about the nature and location of the pain. When a specific pain disorder is not documented or the encounter is to manage the cause of the pain, the underlying condition is coded and sequenced as the principal diagnosis.2

Chronic Pain Disorders

G89.0

Central pain syndrome

G89.29

Other chronic pain

G89.3

Neoplasm related pain (acute)(chronic)

G89.4

Chronic pain syndrome

Note: "Central pain syndrome" and "chronic pain syndrome" are diagnoses and must be specifically documented to assign code G89.0 or G89.4. Similarly, pain must be documented as "chronic" to assign code G89.29, and must be

documented as being related to the neoplasm to assign G89.3.

Reflex Sympathetic Dystrophy (RSD) (Complex Regional Pain Syndrome I) (CRPS I)

And

Causalgia (Complex Regional Pain Syndrome II) (CRPS II)

G90.521 G90.522 G90.523 G57.70 G57.71 G57.72

Complex regional pain syndrome I of right lower limb Complex regional pain syndrome I of left lower limb Complex regional pain syndrome I of lower limb, bilateral Causalgia of unspecified lower limb Causalgia of right lower limb Causalgia of left lower limb

G57.73

Causalgia of bilateral lower limbs

Note: ICD-10-CM does not have a default code for "Complex Regional Pain Syndrome"; type I or II must be specified. Pain codes from the G89 series should not be assigned separately with the codes for reflex sympathetic dystrophy or causalgia because pain is a known component of these disorders.

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TARGETED DRUG DELIVERY

COMMONLY BILLED CODES

ICD-10-CM1 Diagnosis Codes continued

Underlying Causes of

Postherpetic Neuropathy/Neuralgia

Chronic Pain (Non-Cancer)

B02.22

Postherpetic trigeminal neuralgia

B02.23

Postherpetic polyneuropathy

B02.29

Other postherpetic nervous system involvement (radiculopathy)

Arachnoiditis

G03.1

Chronic meningitis

G03.9

Meningitis, unspecified

Peripheral Neuropathy of Lower Extremities

G57.90

Unspecified mononeuropathy of unspecified lower limb

G57.91

Unspecified mononeuropathy of right lower limb

G57.92

Unspecified mononeuropathy of left lower limb

G57.93

Unspecified mononeuropathy of bilateral lower limbs

Radiculopathy

M51.16

Intervertebral disc disorders with radiculopathy, lumbar region

M51.17

Intervertebral disc disorders with radiculopathy, lumbosacral region

M54.16

Radiculopathy, lumbar region

M54.17

Radiculopathy, lumbosacral region

Osteoporosis-Related Fracture, Vertebra3

M80.08xA M80.88xA

Age-related osteoporosis with current pathological fracture, vertebra(e) Other osteoporosis with current pathological fracture, vertebra(e)

Postlaminectomy Syndrome

M96.1

Postlaminectomy syndrome, not elsewhere classified

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TARGETED DRUG DELIVERY

COMMONLY BILLED CODES

ICD-10-CM1 Diagnosis Codes continued

Underlying Causes of Chronic Pain (Cancer)4

C15.3-C15.9 C16.0-C16.9

Malignant neoplasm of esophagus Malignant neoplasm of stomach

C18.0-C18.9, C19, C20, Malignant neoplasm of colon, rectosigmoid junction, rectum, anus, C21.0-C21.8, C78.5 and anal canal

C22.0-C22.9, C78.7 Malignant neoplasm of liver and intrahepatic bile ducts

C25.0-C25.9

Malignant neoplasm of pancreas

C33, C34.00-C34.92 Malignant neoplasm of trachea, bronchus and lung C78.00-C78.02

C40.00-C40.92 Malignant neoplasm of bones C41.0-C41.9, C79.51

C50.011-C50.929 Malignant neoplasm of breast

C53.0-C53.9

Malignant neoplasm of cervix

C54.0-C54.9, C55 Malignant neoplasm of uterus

C56.1-C56.9 C79.60-C79.63

C61

Malignant neoplasm of ovary Malignant neoplasm of prostate

C62.00-C62.92 Malignant neoplasm of testis

C64.1-C64.9, C65.1-C65.9, C79.00-C79.02

Malignant neoplasm of kidney

C67.0-C67.9, C79.11 Malignant neoplasm of bladder

C71.0-C71.9 C72.0-C72.9

C79.31 C79.40-C79.49

Malignant neoplasm of brain, spinal cord, and other central nervous system structures

M84.58xA

Pathological fracture in neoplastic disease, other specified site (vertebrae)3

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