How To Use CPT Code 1126F

CPT 1126F describes the quantification of pain severity in patients undergoing chemotherapy or radiotherapy for cancer. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 1126F?

CPT 1126F can be used to report the absence of pain in patients with cancer who are receiving chemotherapy or radiotherapy. This code is used when the provider measures the severity of pain during the measurement period and determines that the patient does not experience pain.

2. Official Description

The official description of CPT code 1126F is: ‘Pain severity quantified; no pain present (COA) (ONC)’

3. Procedure

1. The provider uses various instruments, such as numerical rating scales or visual analog scales, to quantify the severity of the patient’s pain.
2. The provider examines the patient who is undergoing chemotherapy or radiotherapy for cancer.
3. The provider measures the severity of pain experienced by the patient and reports it as not present using CPT code 1126F.
4. This measure should be reported at each visit during the measurement year, and the provider should utilize at least one comprehensive pain screening or pain management plan.
5. The provider documents the absence of pain in the patient’s healthcare record on the date of the encounter.

4. Qualifying circumstances

CPT 1126F is used for patients with cancer who are undergoing chemotherapy or radiotherapy. The provider must measure the severity of pain during the measurement period and determine that the patient does not experience pain. This code is specific to pain quantification in the context of cancer treatment.

5. When to use CPT code 1126F

CPT code 1126F should be used when the provider measures the severity of pain in patients with cancer who are undergoing chemotherapy or radiotherapy and determines that the patient does not experience pain. It should be reported at each visit during the measurement year and when the provider utilizes at least one comprehensive pain screening or pain management plan.

6. Documentation requirements

To support a claim for CPT code 1126F, the provider must document the following information:

• Diagnosis of cancer
• Specific pain quantification instruments used
• Date of the encounter
• Absence of pain

7. Billing guidelines

When billing for CPT code 1126F, ensure that the provider accurately measures the severity of pain and determines that the patient does not experience pain. This code should be reported at each visit during the measurement year and when a comprehensive pain screening or pain management plan is utilized. It should not be reported with other pain severity quantification codes.

8. Historical information

CPT code 1126F was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates to the code since its addition.

9. Examples

1. A provider measures the severity of pain in a patient undergoing chemotherapy and determines that the patient does not experience pain.
2. A provider utilizes a visual analog scale to quantify the severity of pain in a patient receiving radiotherapy and reports the absence of pain.
3. A provider uses a numerical rating scale to measure the severity of pain in a cancer patient during a routine visit and documents that the patient does not experience pain.
4. A provider employs a verbal rating scale to assess the severity of pain in a patient undergoing chemotherapy and reports no pain present.
5. A provider utilizes a comprehensive pain screening tool to quantify the severity of pain in a patient receiving radiotherapy and determines that the patient does not experience pain.
6. A provider uses a visual analog scale to measure the severity of pain in a cancer patient during a follow-up visit and documents the absence of pain.
7. A provider employs a numerical rating scale to assess the severity of pain in a patient undergoing chemotherapy and reports no pain present.
8. A provider utilizes a verbal rating scale to quantify the severity of pain in a patient receiving radiotherapy and determines that the patient does not experience pain.
9. A provider uses a comprehensive pain management plan to assess the severity of pain in a cancer patient during a routine visit and documents the absence of pain.
10. A provider employs a visual analog scale to measure the severity of pain in a patient undergoing chemotherapy and reports no pain present.