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Mod 25 with OMT & Acupuncture

  1. Cool Mod 25 with OMT & Acupuncture
    Medical Coding Books
    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?

  2. #2
    Milwaukee WI
    Default 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

  3. #3
    North Carolina
    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.

  4. Default
    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!

  5. Default
    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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