decisionhealth Newsletters, Coder Pink Sheets - 2010 Issue 12 (December)
Transforaminals in 2011: Make sure stricter definition doesn’t choke off your payments
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Article Overview
This premium article discusses a 2011 CPT change involving transforaminal epidural injections and the related payment implications for physician practices, ambulatory surgery centers, and pain management groups. It focuses on how the revision affects reimbursement expectations, why Medicare calculations may not fully reflect the service, and what broad contract-review and payer-communication issues practices should consider before the change takes effect.
Why This Topic Matters
The article is relevant to practices that perform transforaminal epidural injections and need to understand how coding and reimbursement changes can affect revenue, contracting, and internal billing processes.
Article Sections
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Background
Introduces the 2011 coding and reimbursement context for transforaminal epidural injections and summarizes the general payment concern discussed in the article.
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Ready, set, negotiate
Covers broad preparation steps for payer discussions, including contract review, fee review, and communication strategy for affected services.
What You Will Learn
- How a 2011 CPT change can affect reimbursement for transforaminal epidural injections
- Why payer contracts may need to be reviewed in light of a coding definition change
- What general factors practices may consider before approaching payers about fees
- Why internal billing and workflow updates may be necessary after the change
Who Should Read This
- Pain management practices
- Physician coders
- Billing staff
- Practice administrators
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
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