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COVID-19 Pain Management Practice Guidelines Published in AAPM Journal

April 7, 2020, CHICAGO – The official journal of the American Academy of Pain Medicine (AAPM), Pain Medicine, has published a practice guidelines article titled “Pain Management Best Practices from Multispecialty Organizations during the COVID-19 Pandemic and Public Health Crises” to assist pain medicine providers, health care leaders, and regulatory bodies as they respond to the COVID-19 crisis.

Ensuring that persons experiencing pain have continued access to pain management services throughout this global pandemic is crucial. The Pain Medicine guidelines, which are supported by the medical societies and organizations listed below, addresses how pain medicine specialists can continue to offer vital pain care while also implementing strategies designed to keep themselves, their clinical staff members, and their patients safe.

“The need for providers and patients to responsibly address the COVID crisis must be balanced with the public health benefits inherent in the treatment of pain, as well as with the welfare of healthcare providers. Walking this ‘fine balance’ is critically important for pain specialists right now,” says AAPM President, Ajay Wasan, MD MSc, who co-authored the guidelines. “The purpose of this article is to offer guidance to help pain providers mitigate procedure risks, establish plans that protect clinicians and patients, implement telemedicine options, and triage procedures and clinical visits during the COVID-19 outbreak appropriately.”

Given the urgent need for this information to be publicly available as quickly as possible, the Pain Medicine guidelines article has been published and is freely accessible as an Accepted Manuscript. The Accepted Manuscript is the final draft author manuscript, as accepted for publication by the journal, including modifications based on referees’ suggestions but before it has undergone copyediting, typesetting, or proof correction. Within a few weeks, the Accepted Manuscript will be replaced by a corrected proof, known as the Version of Record. Neither the Accepted Manuscript nor the Version of Record may be hosted by any organization or journal other than Pain Medicine, but anyone is welcome to link to the guideline.

AAPM member and Director-at-Large Steven P. Cohen, MD spearheaded efforts to create this guideline and is its lead author. Dr. Cohen worked with representatives from the following associations to gather input and support for recommendations included in the article:

  • American Academy of Pain Medicine (AAPM)
  • American Academy of Physical Medicine and Rehabilitation (AAPMR)  
  • American Society of Anesthesiologists (ASA)
  • American Society of Regional Anesthesia and Pain Medicine (ASRA)
  • North American Neuromodulation Society (NANS)
  • Spine Intervention Society (SIS)
  • United States Military
  • Veteran Health Administration
  • World Institute of Pain (WIP)
A panel of guideline authors representing the multispecialty organizations that assisted in developing these recommendations will present a live webinar on Monday, April 13, 6-7:15 pm CT. This live CME activity is free, and registration is required by logging into an existing AAPM account or creating a new account. Learn more and register. A recording of the webinar will be available following the live event.

View a video conversation with two of the guidelines’ authors, ​Stephen P. Cohen, MD ​and ​Friedhelm Sandbrink, MD​. 

About AAPM

The American Academy of Pain Medicine is the premier medical association for pain physicians and their treatment teams with some 2,000 members. Now in its 37th year of service, the Academy’s mission is to advance and promote the full spectrum of multidisciplinary pain care, education, advocacy, and research to improve function and quality of life for people in pain. Information is available on the Academy’s website at painmed.org

Staying Sane and Current on COVID-19

COVID-19 presents new challenges for everyone. However, healthcare professionals are facing unique personal and professional challenges within the context of this rapidly shifting landscape. AAPM Member Beth Darnall, PhD, offers advice and resources, by specialty, for those caring for patients during the COVID-19 crisis in this MedPage Today article. Full story.

AMA Releases Coding Advice Related to COVID-19

  The AMA has created a quick reference flow chart for CPT reporting for COVID-19 testing that outlines coding options for testing patients for COVID-19. Although testing is not likely to be ordered by pain medicine practices, the flow chart summarizes the coding options for telemedicine, telephone and “virtual check-in” visits. Most of these options were explained in a previous article.

Physicians have contacted AAPM with concerns for caring for patients who are high-risk and do not have internet capabilities or skills. Medicare does not cover the codes for telephone services. However, Medicare pays for “virtual check-ins” (brief communication technology-based service) for patients to communicate with their doctors and avoid unnecessary trips to the doctor’s office. These virtual check-ins are for patients with an established (or existing) relationship with a physician where the communication is not related to a medical visit within the previous 7 days, and does not lead to a medical visit within the next 24 hours (or soonest appointment available and involves 5-10 minutes of medical discussion. The service is reported using HCPCS code G2012.

Patients must verbally consent to receive virtual check-in services; however, you can advise patients of the availability of the service. Medicare coinsurance and deductible apply to these services. The national average reimbursement for code G2012 is about $15.

A new page on the AMA website address CMS payment policies & regulatory flexibilities during COVID-19 emergency.

Message from the AAPM President about COVID-19

​AAPM has been monitoring CDC guidance related to COVID-19. Today AAPM President Ajay D. Wasan, MD MSc issued the following message to members.

Dear Colleagues:

By now I am sure that you have received many lengthy COVID emails and so I will get to the point. AAPM has been monitoring CDC guidance related to COVID-19, and we offer the following thoughts to our members:

The CDC suggests delaying and not having patients come into the office for elective medical care. Certainly, it is a difficult issue to determine to what extent pain care is ‘elective’ vs. medically necessary, and the consideration for limiting outpatient pain care also depends on the extent of COVID-19 and the risk of acquiring it in your area.

At the very least it seems prudent to reschedule elective procedures/injections, initial evaluations, and follow-up visits in those patients at a high risk of complications from COVID-19. These subgroups include those 65 years old or older, those with important medical comorbidities (such as cardiac disease, pulmonary disease, or diabetes), the immunocompromised, and patients coming from nursing homes or long-term care facilities.

The CDC and the Trump administration have encouraged telemedicine visits in place of in-person follow up visits for elective medical care. The DEA has confirmed that it is reasonable in this crisis to renew controlled substance prescriptions after a telemedicine evaluation or telephone discussion with the patient when appropriate and if consistent with state law (such as by electronic prescribing to avoid a high risk patient coming in for a routine opioid follow up visit).

CMS has also relaxed the requirements for using telemedicine codes for billing and they have pledged to pay for these codes equivalent to in person visits. There are weblinks below that explain further how to use these codes effectively in your practice.

We are all struggling to adjust—both professionally and personally. In the coming weeks, our American Academy of Pain Medicine (AAPM) will work to keep us abreast of developments that are specific to our practice areas. Initially, we are providing updated billing and coding guidance that are consistent with the latest messaging coming from CMS regarding the expanded use of telemedicine codes. These insights were prepared under the guidance of the AAPM’s Coding and Reimbursement Committee, which represents our specialty at the CPT and RUC, and regularly provides information to AAPM members in the bi-monthly AAPM e-Newsletter.

Our AAPM will continue to monitor developments that are particular to pain medicine. Thank you for your continuing efforts on behalf of our patients.

Ajay D. Wasan, MD MSc
President AAPM

CMS Approves First State Request for 1135 Medicaid Waiver in Florida

The state’s approval letter can be found here, and includes flexibilities that enable the state to waive prior authorization requirements to remove barriers to needed services, streamline provider enrollment processes to ensure access to care for beneficiaries, allow care to be provided in alternative settings in the event a facility is evacuated to an unlicensed facility, suspend certain nursing home screening requirements to provide necessary administrative relief, and extend deadlines for appeals and state fair hearing requests. These flexibilities will enable the state to focus its resources on combatting this outbreak and provide the best possible care to Medicaid beneficiaries in their state. 

Full story.

President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak

The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

Full story.

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