TerelNewton.com - Provider FAQs

The Provider FAQ offers concise, evidence-based answers to common clinical, compliance, and operational questions. It supports physicians, NPs, PAs, and allied staff with guidance on patient safety, procedural protocols, documentation, billing, and regulatory standards.

Designed by Dr. Newton as an educator, the section emphasizes practical teaching points, covering appropriate treatments, absolute contraindications, informed consent, coding challenges, and patient communication strategies. It also highlights opportunities for continuing education, mentorship, and collaboration. This resource ensures providers have quick access to clarity, confidence, and consistency in delivering safe, compliant, and effective care across diverse patient populations.

Pain Management Coding & Bracing + Medicine Quick-Reference

Cervical Region

ICD-10: Cervicalgia M54.2, Cervical radiculopathy M54.12, Cervical disc displacement unspecified M50.20, C2–C3 M50.21, C3–C4 M50.22, C4–C5 M50.23, C5–C6 M50.30, C6–C7 M50.31, C7–T1 M50.32, Other specified M50.33, Cervical spondylosis M47.812, Cervical strain S16.1XXA.

CPT: ESI interlaminar 62321, TFESI 64479/64480, Facet MBB 64490–64492, Facet RFA 64633–64634, Trigger point 20552 (1–2 groups), 20553 (≥3 groups).

Bracing: Soft cervical collar L0120.

Thoracic Region

ICD-10: Thoracic pain M54.6, Thoracic radiculopathy M54.14, Thoracic disc displacement unspecified M51.24, Upper thoracic M51.25, Mid thoracic M51.26, Lower thoracic M51.27, Thoracic spondylosis M47.814.

CPT: ESI interlaminar 62321, TFESI 64479/64480, Facet MBB 64490–64492, Facet RFA 64633–64634.

Bracing: Clavicle/posture support L3650.

Lumbar & Lumbosacral Region

ICD-10: Low back pain M54.50 (M54.5 not billable), Lumbar radiculopathy M54.16, Lumbosacral radiculopathy M54.17, Lumbar stenosis M48.061, Lumbar spondylosis M47.816, Lumbar disc displacement unspecified M51.26, L1–L2 M51.27, L2–L3 M51.28, L3–L4 M51.29, L4–L5 M51.36, L5–S1 M51.37, Lumbago with right sciatica M54.41, with left sciatica M54.42.

CPT: ESI interlaminar 62323, TFESI 64483/64484, Facet MBB 64493–64495, Facet RFA 64635–64636, SI joint injection 27096, Trigger point 20552 (1–2 groups), 20553 (≥3 groups).

Bracing: Lumbar orthosis Horizon 637 L0637/L0631, SI belt L0621, Lumbosacral support L0627.

Coccyx (Coccydynia)

ICD-10: Coccydynia M53.3.

CPT: Caudal ESI 62323, Ganglion impar block 64520 (payer dependent).

Bracing: Coccyx cushion/donut (supply, not L-code).

Headache & Migraine

ICD-10: Acute post-traumatic G44.311, Chronic post-traumatic G44.321, Intractable migraine without aura G43.019, with aura G43.119, Chronic migraine without aura G43.709, with aura G43.719.

CPT: Greater occipital nerve block 64405, Trigger point 20552–20553, Botox 64615.

Bracing: Not applicable.

Knee

ICD-10: Knee pain R M25.561, L M25.562, Primary OA R M17.11, L M17.12, Meniscus tear S83.2XXA, Sprains ACL/PCL/MCL/LCL S83.4–S83.5.

CPT: Large joint injection 20610, Genicular block 64454, Genicular RFA 64624.

Bracing: OA unloading brace L1843, Functional brace L1832.

Wrist & Hand

ICD-10: Wrist pain R M25.531, L M25.532, Carpal tunnel R G56.01, L G56.02, de Quervain M65.4, Thumb sprain S63.6–.

CPT: Small joint injection 20600/20605, Tendon sheath 20550, Peripheral nerve block 64450.

Bracing: Wrist brace L3908, Wrist with thumb spica L3807, Thumb support L3923.

Shoulder

ICD-10: Shoulder pain R M25.511, L M25.512, Rotator cuff tendinopathy M75.1–, AC sprain S43.5–, Clavicle fracture S42.0–.

CPT: Large joint injection 20610, Suprascapular/peripheral block 64450.

Bracing: Shoulder immobilizer L3670, Clavicle support L3650.

Ankle & Foot

ICD-10: Ankle pain R M25.571, L M25.572, Acute sprain S93.4–, Chronic instability M25.37–, Plantar fasciitis M72.2.

CPT: Small joint injection 20605, Tendon sheath 20550, Peripheral nerve 64450.

Bracing: Walking boot L4360, Air stirrup L4350, Lace-up L1902, Ultra High-5 L1906, Night splint L4398.

Medication & Ancillary Codes

Injectables (J-codes, supply codes)

Depo-Medrol (methylprednisolone acetate) J1040 (80 mg), J1030 (40 mg), J1020 (20 mg).
Kenalog (triamcinolone acetonide) J3301 (10 mg increments).
Toradol (ketorolac tromethamine) J1885 (per 15 mg).
PRP (platelet-rich plasma) 0232T (Category III, unlisted biologic injection).

Monitoring

Pulse oximetry, single measurement 94760.
Pulse oximetry, continuous 94761.

Anxiolysis / Office Sedation

Nitrous oxide analgesia/anxiolysis 01991 (per 15 min, anesthesia for diagnostic/therapeutic nerve blocks or injections, when sedation is medically necessary).
Minimal/moderate sedation 99151 (initial 15 min, <5 years), 99152 (initial 15 min, ≥5 years), 99153 (each additional 15 min).

Medication management / E&M

Office/outpatient visits: 99213–99215 (est.), 99203–99205 (new).
Prolonged services 99417 (15 min increment).
Urine drug screen: 80305–80307 (qualitative), G0480–G0483 (quantitative).

⚕️ Clinical Tip: Always document the specific medication, dose, route, indication, and medical necessity. PRP and biologics often require self-pay or prior authorization. Anxiolysis with nitrous should include consent, monitoring, and time-based documentation.

Provider FAQ

This FAQ equips physicians, nurse practitioners, physician assistants, and allied staff with practical, evidence-based answers. It is designed to improve clarity, compliance, and safety in daily clinical practice, while also serving as a teaching tool.

Clinical Care & Safety

Which patients are appropriate for interventional or cannabis therapies?
Appropriate candidates include patients with chronic musculoskeletal pain (arthritis, degenerative spine disease), neuropathic pain (radiculopathy, postherpetic neuralgia, diabetic neuropathy), migraines, fibromyalgia, cancer-related pain, or spasticity who have not achieved adequate relief with conservative care. State and institutional guidelines should be followed for cannabis-based therapies. In elderly patients and those with cardiopulmonary disease, risk stratification and clearance may be required.

What are absolute contraindications?

Active local or systemic infection
Uncontrolled bleeding disorders or anticoagulation that cannot be reversed
Untreated bowel obstruction
Severe, unstable cardiopulmonary disease (e.g., COPD exacerbation, CHF, uncontrolled arrhythmia)
Inability to provide informed consent (without a legal representative)
Documented allergy to planned injectates or anesthetics

Relative contraindications: uncontrolled diabetes, pregnancy (for certain injectates), recent high-dose steroid exposure, immunosuppression.

Procedural Guidance

Which medications may be used in office-based injections?
Providers should choose injectates based on the patient’s condition, comorbidities, and payer coverage. Below are common agents with billing clarifications:

Depo-Medrol (methylprednisolone acetate) │ J1030 (40 mg), J1040 (80 mg) │ Widely used for intra-articular and soft tissue injections.
Kenalog (triamcinolone acetonide) │ J3301 (10 mg) │ Standard corticosteroid for joint, bursa, or tendon injection.
Celestone (betamethasone sodium phosphate/acetate) │ J0702 (3 mg), J0704 (6 mg), J0706 (12 mg) │ Useful in spine and joint injections.
Dexamethasone sodium phosphate │ J1100 (1 mg) │ Preferred in epidural steroid injections due to low particulate risk.
Toradol (ketorolac tromethamine) │ J1885 (per 15 mg) │ Non-steroidal option for musculoskeletal pain injections.
Lidocaine │ J2001 (20 mL) is for IV infusion use only. For local infiltration and blocks, lidocaine is bundled in the procedure and not separately billable.
Bupivacaine (Marcaine) │ J3490 (unclassified drug) │ Long-acting local anesthetic; generally bundled in procedure.
Ropivacaine │ J2795 (per 1 mg) │ Used in regional anesthesia and blocks; billable when not bundled.
Hyaluronic acid products (Synvisc, Euflexxa, Orthovisc, Supartz, Monovisc, Durolane, Gel-One, Hymovis) │ J7321–J7329 (brand-specific) │ Ensure exact code matches brand to avoid denials.
Platelet-rich plasma (PRP) │ 0232T (injection, platelet-rich plasma, any site) │ T-code, not J-code. Coverage limited; often cash-pay.
Amniotic/placental tissue products │ J3490 (unclassified biologic) │ Must document product, lot, and route.
Botulinum toxin (Botox, Dysport, Xeomin) │ J0585 (onabotulinumtoxinA, per unit), J0586 (abobotulinumtoxinA, per 5 units), J0588 (incobotulinumtoxinA, per unit) │ Prior authorization usually required.

When should anesthesia services be billed under 01999?
When anesthesia support does not align with standard anesthesia codes. Documentation must include:

Medical necessity (high-risk comorbidities, anticipated airway compromise, extensive procedure)
Complexity of anesthetic management
Monitoring requirements (e.g., invasive lines, extended recovery)

Compliance & Documentation

What must be documented for consent?

Indication and medical necessity
Risks, benefits, and alternatives (including conservative care)
Expected outcomes and limitations
Patient’s opportunity to ask questions
Confirmation of patient understanding (teach-back encouraged)
Provider signature and attestation

How do providers ensure compliance?

Record injectate name, dose, route, lot number, and expiration date
Document informed consent for every procedure
Use HIPAA-compliant EMRs (e.g., eClinicalWorks, Practice Fusion)
Follow DEA and state prescribing regulations
Maintain audit-ready records for CMS and payers

Patient Communication

How should risks and benefits be explained?
Use plain language, visual aids, and confirm understanding with teach-back. Provide both verbal and written materials. Stress that injections are part of a multimodal plan that may also include exercise, nutrition, and behavioral therapies.

What are best practices for elderly or high-risk patients?

Screen for polypharmacy and interactions
Simplify medication regimens where possible
Monitor for cognitive changes and fall risk
Engage caregivers in all education and follow-up
Schedule closer follow-up after interventions to detect complications early

Professional Development

What education is available for providers?
CME and CEU opportunities in interventional pain medicine, cannabis pharmacology, opioid-sparing strategies, compliance, and AI in healthcare. Training is offered through workshops, online modules, and case-based seminars.

How can providers contribute to the program?

Mentor residents, fellows, and new providers
Publish or present case reports and outcome data
Participate in quality improvement initiatives
Collaborate in clinical trials or observational studies with Dr. Newton’s network

How often should providers update knowledge?

At least annually through CME/CEU activities
Quarterly review of payer coverage, coding updates, and compliance requirements
Ongoing participation in mentorship and collaborative learning opportunities

👉 Key Teaching Points:

Not all injectates are separately billable (e.g., lidocaine, bupivacaine).
Hyaluronic acids require exact brand-specific J-codes.
PRP requires T-code 0232T; coverage is limited.
Always document lot numbers for biologics.
Consent must reflect patient comprehension, not just signature.

How to Bill a Provider to Provider call ...

The most relevant CPT codes are:

99446 – Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including written report to the treating/requesting physician; 5–10 minutes of medical consultative discussion and review.
99447 – Same as above; 11–20 minutes.
99448 – Same; 21–30 minutes.
99449 – Same; 31+ minutes.

🔹 Key Points for Compliance:

Must be a physician-to-physician (or other qualified health care professional) consult, not directly with the patient.
Requires a verbal discussion and follow-up written report/documentation (your note does this = DOCUMENT THE INFORMATION DISCUSSED IN THE CHART)
Do not use these codes if the discussion is less than 5 minutes or if it occurs during transfer of care.
If the patient was present on the call (not in this case), you would consider telephone E/M codes (99441–99443) instead.

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