How To Use CPT Code 1130F

CPT 1130F describes the assessment of back pain and function, including pain assessment, functional status, patient history, presence or absence of “red flags,” assessment of prior treatment and response, and employment status. This article will cover the description, official guidelines, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 1130F?

CPT 1130F can be used to assess back pain and function in patients. This code covers various aspects of the assessment, including pain assessment, functional status, patient history, presence or absence of “red flags,” assessment of prior treatment and response, and employment status. It is used to evaluate the severity and impact of back pain on a patient’s daily life.

2. Official Description

The official description of CPT code 1130F is: ‘Back pain and function assessed, including all of the following: Pain assessment and functional status and patient history, including notation of presence or absence of “red flags” (warning signs) and assessment of prior treatment and response, and employment status (BkP)’

3. Procedure

1. The healthcare provider performs a comprehensive evaluation of the patient’s back pain, including pain assessment, functional status, and patient history.
2. The provider notes any “red flags” or warning signs that may require immediate medical attention.
3. Prior treatment and response are assessed to understand the patient’s previous experiences with back pain management.
4. The provider also evaluates the patient’s employment status to determine any potential impact on their back pain.
5. All findings from the assessment are documented in the patient’s medical record.

4. Qualifying circumstances

CPT 1130F is applicable to patients who present with back pain and require a comprehensive assessment. The assessment helps determine the severity of the pain, functional limitations, presence or absence of warning signs, prior treatment and response, and the impact on employment status. It is important to note that this code is specific to the assessment of back pain and should not be used for other conditions.

5. When to use CPT code 1130F

CPT code 1130F should be used when a healthcare provider performs a complete evaluation of a patient presenting with back pain. It is appropriate to use this code for the initial visit when assessing back pain for the first time. However, if the patient has already seen multiple providers for the same back pain, each provider can bill for their respective initial visit. This code should not be used for subsequent visits or follow-up assessments.

6. Documentation requirements

To support a claim for CPT code 1130F, the healthcare provider must document the following information:

• Patient’s complaint of back pain and any associated symptoms
• Pain assessment using standardized tools such as SF 36, Roland Morris disability questionnaire, or visual analog scale
• Evaluation of functional limitations and activity restrictions caused by back pain
• Presence or absence of “red flags” that require immediate medical attention
• History of prior treatment and response to back pain management
• Assessment of the patient’s employment status and its impact on back pain
• Date of the assessment and signature of the healthcare provider

7. Billing guidelines

When billing for CPT code 1130F, ensure that the assessment is comprehensive and covers all the components mentioned in the official description. This code should not be reported with other codes unless specified by specific payer guidelines. It is important to follow the documentation requirements and provide sufficient details to support the medical necessity of the assessment.

8. Historical information

CPT code 1130F was added to the Current Procedural Terminology system on January 1, 2009. The code underwent a change on January 1, 2013, to include additional components in the assessment, such as notation of presence or absence of “red flags” and assessment of prior treatment and response.

9. Examples

1. A patient presents with back pain for the first time, and the healthcare provider assesses the pain intensity, functional limitations, patient history, presence or absence of warning signs, and employment status.
2. A construction worker complains of back pain, and the provider evaluates the pain severity, impact on daily activities, history of previous treatment, and the effect on the patient’s ability to work.
3. A patient with a history of back pain visits a new healthcare provider, and the provider assesses the current pain level, functional limitations, previous treatment outcomes, and any red flags that may require immediate attention.
4. An office worker reports back pain, and the provider evaluates the pain intensity, impact on work productivity, history of treatment, and any warning signs that may indicate a more serious condition.
5. A patient presents with back pain after a car accident, and the provider assesses the pain severity, functional limitations, history of trauma, and any red flags that may indicate a spinal injury.
6. A healthcare provider evaluates a patient with chronic back pain, assessing the pain intensity, impact on daily activities, previous treatment outcomes, and any red flags that may require further investigation.
7. A patient complains of back pain and visits a provider for the first time, and the provider assesses the pain severity, functional limitations, patient history, presence or absence of warning signs, and employment status.
8. A manual laborer presents with back pain, and the provider evaluates the pain intensity, impact on work performance, history of previous treatment, and any red flags that may indicate a more serious condition.
9. A patient with a history of back pain seeks a second opinion, and the provider assesses the current pain level, functional limitations, previous treatment outcomes, and any red flags that may require immediate attention.
10. An office worker reports back pain, and the provider evaluates the pain intensity, impact on work productivity, history of treatment, and any warning signs that may indicate a more serious condition.