New coding guidance: Watch out for new payer policies that could impinge your payments

Why This Topic Matters

Policy changes from a major payer can affect whether common pain procedures are paid, denied, or require additional documentation. Understanding the scope of the revisions helps practices reduce avoidable denials and align records with payer expectations.

Article Sections

1. Aetna pain policy updates

   Introduces the payer policy changes affecting pain-related procedures and the types of claims most likely to be impacted.

2. New requirements for facets, epidurals

   Summarizes revised guidance affecting back-pain procedures and the broader documentation themes applied to these services.

3. Diagnostic facet blocks

   Covers the diagnostic facet block policy area, including the general clinical and documentation themes discussed in the article.

4. New criteria for facet denervation

   Describes the updated policy area for facet denervation, including frequency and follow-up considerations.

5. Diagnostic and therapeutic epidurals

   Addresses the revised epidural policy framework and the distinctions between diagnostic and therapeutic treatment phases.

6. Guidance for both phases

   Notes the shared documentation and programmatic requirements discussed for epidural care across both phases.