It's official: New epidural policies will go live before the year ends

by: Julia Kyles, CPC Oct 21, 2021

Practices that perform intralaminar and transforaminal epidural injections to manage chronic pain should add 'Implement the new local coverage determination (LCD)' to their to-do list, PBN Blog has learned from Amy Turner, RN, BSN, MMHC, CPC, CHC, CHIAP, director of advisory solutions for abeo.

As of 9 a.m. ET, the following MACs had posted final versions of the LCD and related billing and coding articles. The LCDs and articles have a Dec. 5 effective date:

CGS.
National Government Services.
Palmetto GBA.
WPS.

Practices in the jurisdictions for First Coast Service Options, Novitas and Noridian should expect to see their final LCDs and articles soon.

Turner has been keeping a close eye on the proposed uniform LCD and article that Medicare Administrative Contractors collaborated on and released earlier this year. She is presenting on the update process today at 1 p.m., ET, during the webinar Epidural Update: Prepare for the Uniform Policy for Translaminar, Transforaminal, and Caudal Epidurals.

Her main takeaway – The MACs made some clarifications and tweaks in response to comments, but they did not make radical changes to the proposed policies. Practices should start preparing now so they don't end the year with a mound of denials.

Here are four quick hits from the final policy:

Modifier KX will be required for diagnostic blocks.
The language on drugs and dosage levels has been clarified.
The policies will not apply to lumbar epidurals performed as part of a pain pump trial.
There will be more restrictions on the use of deeper levels of sedation in conjunction with epidurals

You can get more details and earn 1 AAPC CEU by attending the live webinar today – Oct 21 – at 1 p.m., ET, or purchasing an on-demand recording. Registration for the live event includes the on-demand recording.

Blog Tags: claims processing, CMS

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