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osteopathic manipulation

  1. Default osteopathic manipulation
    Exam Training Packages
    D.O. performed services.
    Claim submitted to Highmark Medicare as follows:

    98925
    62311-59

    Allowed 98925, disallowed 62311-59 as follows:
    B15 THIS SERVICE/PROCEDURE REQUIRES THAT A QUALIFYING SERVICE/PROCEDURE BE RECEIVED AND COVERED. THE QUALIFYING OTHER SERVICE/PROCEDURE HAS NOT BEEN RECEIVED/ADJUDICATED. NOTE: REFER TO THE 835 HEALTHCARE POLICY IDENTIFICATION SEGMENT (LOOP 2110 SERVICE PAYMENT INFORMATION REF), IF PRESENT. AND,
    M80 NOT COVERED WHEN PERFORMED DURING THE SAME SESSION/DATE AS A PREVIOUSLY PROCESSED SERVICE FOR THE PATIENT.

    I searched Highmark Medicare and was unsuccessful at finding clarification for the 835 Healthcare Policy. Are they saying that the ESI is inclusive of the manipulation?

    HELP!

  2. #2
    Location
    Denver Colorado
    Posts
    279
    Default
    The lumbar ESI code, 62311, is bundled by CCI edits as a column 2 code into the osteopathic manipulation code, 98925. This edit carries a "0" modifier indicator which means it can not be bypassed for any reason.

    The two services need to be performed on different dates of service.

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