Interventional Procedure RoundUp: OIG says transforaminal injections often billed incorrectly

Why This Topic Matters

It highlights a Medicare compliance issue affecting interventional pain procedure billing and signals that contractors may adopt stricter review and coverage policies. Readers in coding and compliance can use it to understand the broader audit and payment-risk environment for these services.

Article Sections

1. OIG report findings and payment trends

   Summarizes the OIG review of Medicare payments for transforaminal epidural injection services and the overall change in allowed payments over time. It also describes the scope of claim review and the reported error rate.

2. Types of billing problems identified

   Describes the broad categories of issues found in the review, including documentation concerns, medical necessity concerns, and coding-related errors. It also notes the general nature of the improper billing patterns identified.

3. Recommended contractor and CMS actions

   Outlines the types of oversight, coverage, and claims-processing actions OIG wants CMS and its contractors to consider. The section focuses on policy enforcement and medical review rather than specific billing instructions.

4. Related OIG scrutiny of other interventional procedures

   Places the transforaminal injection report in the context of prior OIG attention to other interventional procedure services. It briefly references another Medicare payment integrity review in a related specialty area.