Medicare Compliance & Reimbursement

Avoid appending modifier 25 to all cases -- instead, focus on medical necessity in the notes. Because osteopathic physicians (D.O.s or osteopaths) are fully licensed physicians who operate under the same licensing and certification rules as medical doctors (MDs), most of their billing matters are handled in the traditional manner. But because D.O.s also perform osteopathic manipulative treatment, or OMT (98925-98929), many coders have trouble distinguishing between OMT and chiropractic manipulative treatment (CMT, 98940-98943) or manual therapy techniques (97140). Coders who bill for osteopathic services should remember to treat OMT as any other procedure or modality: If it's performed with an E/M service (99201-99215, outpatient), the E/M code should be appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Clearing the Issue: OMT vs. CMT One common mistake that coders who are new to D.O. [...]