Specialty
Interventional Pain Management
Top denial drivers
- Prior injection relief not quantified by percentage, duration, or change in function
- Depression screening completed but not documented as a result plus a follow-up plan
- History, exam, and imaging not each stated explicitly against the payer's coverage policy
What reviewers expect to see
- Percentage and duration of relief from prior injections, and change in function
- A documented depression screening result and a follow-up plan
- History, physical exam, and imaging that matches the diagnosis, mapped to the specific payer policy in effect
Medicare ASM relevance
Interventional pain management is part of the ASM low back pain cohort. ReCapture is building ASM measure mapping (functional status, depression screening, BMI follow-up, high-risk medication review) on top of its production denial-recovery engine.