Wiki Mod 25 with OMT & Acupuncture

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REllifritz

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I have a question regarding charging OMT & Acupuncture along with an E/M service with a modifier 25 for every visit? We have a doctor in our practice who wants me to charge an office visit every time she sees a patient for OMT or Acupuncture. Her documentation is good, including a complaint, ROS, PFSH, and exam. However, I worry that charging an office visit every time puts us at risk for audit, especially when the patient is coming back for the same diagnoses. Any advice?
 
Is the patient coming in for the treatment?

It seems unlikely that a truly "significant separately identifiable" E/M is being performed each and every time the patient comes in for a scheduled treatment - no matter how detailed the history, exam and MDM is.

I would not routinely use the -25 modifier to capture an additional E/M.

F Tessa Bartels, CPC, CEMC
 
I agree...seems like "fluff". I compare this to synvisc injections. Once our orthopods determine the need for synvisc injections, the E/M, usually isn't justified. Have you spoken to physician about your concerns? Often times, it's just a matter of presenting the facts... w/ CMS guidelines as a resource.
 
Thanks, F Tessa, for your input. I haven't been adding an E/M with every treatment our doc does, but I'm trying to convince her that we are putting ourselves at risk. I needed other coders to back me up on this. Appreciate it!
 
Hi Rebecca,
Thanks for the input. I have spoken with the doc regarding my concerns. She knows other practices that are doing this, but I think it puts us at risk and I've expressed my views. I'm presently not adding an E/M with every treatment, only when she has to evaluate a new problem. I just needed support from other coders on this. Thanks again.
 
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