2011 Coding Changes for Transforaminals Affect Reimbursement

November 8th, 2010
 
With the 2011 coding changes to transforaminal injections practices should contact their managed care companies and negotiate higher rates since this will include the fluoroscopy component.

The CPT 2011 coding change for pain management bundles fluoroscopy into all of the transforaminal injection codes.  For many practices the transforaminal codes are a high volume procedure and careful analysis should be done to protect revenue.  With the inclusion of the fluoroscopy component in the procedure code, pain practices stand to lose any money attributed to the 77003 component billed with the 64479-64484 codes.  While evaluating the Medicare RVU's  you must look at both the 2010 RVUs for fluoroscopy and the first level transforaminal and then compare it to the 2011 RVU for the first level of transforaminal.  This will equate to at least a loss of between a half and one RVU for each procedure performed based on your site of service and ownership of the equipment.  For those fee schedules tied to Medicare this is horrible news.  If your managed care contracting is done at as a flat fee service you should address this disparity before the beginning of 2011.  For many groups this loss of income represents between $30.00 and $150 on each episode of care.  These are challenging times for pain management physicians and aggressive contracting is essential to being able to keep revenue at respectable levels.