Wiki Omt-We have a couple

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sarann28

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Hi Everyone,

We have a couple DO's that provider OMT for our patients. Does anyone have any good resources on how to code for OMT?

Thanks,

Sara
 
Medicine section in the AMA CPT 2012 book, page 527. Read the notes concerning E/M services and the codes are pretty straight forward - billing by number of body regions involved.
 
i have a couple DO's I do the coding and billing for as well and they perform OMT along w/ office visits at times or just the OMT by itself. I use either 98925 1-2 regions or 98926 3-4 regions, the DX codes I use are 739.1=cervical, 739.2=thoracic or 739.3=lumbar. This is the same way I coded and billed for a chiropractor I use to work for too. Hopefully this helps:)

Jennifer CPC
 
Omt

I should be more specific, I know what CPT codes to bill for the OMT itself, its the E/M that they want to bill for it. Some think they should be billing a 99214, especially in the MDM, because they believe they are doing more work. I did find something from the AOA, but it was documentation back in 2008, looking for something more current and more explanation when billing the E/M.

Thanks,

Sara
 
If they did an exam, and it's significant and separately identifiable, then yes they can bill the OV. If they're only there for the OMT then you can't bill for the exam because just like CMT there is an exam included. If however they have other issues and the exam is done for that, then you could bill for the E/M with -25 modifier. Just make sure that the documentation supports the fact that it's separate. The diagnoses should show that too, if your pointers for the OMT are the same as for the E/M chances are it won't be paid. Is that what you were looking for? Hope I could help! :)
 
Omt

Aaron,

Thanks for the response, I do understand when to bill and when not to bill the E/M when it comes to OMT. What we're seeing is the provider wants to count all the somatic dysfunction dx's as different problems, than driving the MDM up. What are your thoughts?

Sara
 
I would say as long as there are separate dx codes for each of the problems then yes they can include those and they should be documented. However, dx is not the only component of MDM and you can't base everything on that. You also have to count the amount and/or complexity of data (if they didn't order or review any diagnostics or review other dr's notes then that's minimal). You may not have a moderate MDM regardless of the # of dx. Make sure everything is being taken into account.
 
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