Avoid pitfalls that could result in delays or keep you from receiving maximum reimbursement for the medical services you provide.
To receive the maximum reimbursement for services you provide, it’s more important than ever to ensure proper coding techniques are being used in your practice. Let the AOA help you navigate these changes with valuable resources for OMT reimbursement and other coding issues.
If you’re an AOA member, contact us to receive personal assistance in the areas of chart auditing, sampling, medical record review and credentialing.
The following ICD-10 codes should be used for proper OMT billing:
M99.00 Segmental and somatic dysfunction of head region
M99.01 Segmental and somatic dysfunction of cervical region
M99.02 Segmental and somatic dysfunction of thoracic region
M99.03 Segmental and somatic dysfunction of lumbar region
M99.04 Segmental and somatic dysfunction of sacral region
M99.05 Segmental and somatic dysfunction of pelvic region
M99.06 Segmental and somatic dysfunction of lower extremity
M99.07 Segmental and somatic dysfunction of upper extremity
M99.08 Segmental and somatic dysfunction of rib cage
M99.09 Segmental and somatic dysfunction of abdomen and other regions
The chart below contains the work value for OMT codes 98925-98929:
|RVUs for OMT codes|
|OMT code||Work Value|
Modifier -25 allows for separate reporting for E/M and OMT services provided on the same date for initial and subsequent encounters.
Report the appropriate CPT E/M service (99201-99215) code and the appropriate OMT code (98925-98929). Append Modifier -25 to the E/M service code.
Documenting E/M Service: Document the patient’s chief complaint, history, examination and medical decision making.
Documenting OMT: Document the region(s) identified during the exam diagnosed with but not limited to somatic dysfunction or disorders in the skeletal, arthrodial, myofascial and visceral structures as well as related vasuclar, lymphatic and neural elements. It may be beneficial (but not required) to prepare a procedure note detailing which regions were manipulated, the utilization of techniques and how the patient tolerated the treatment.
In order to accurately report E/M and OMT as separate services, they must be provided on the same date by the same physician. When documenting, it is important to understand how both services are connected, but why OMT should be separate from the E/M service.
Patients typically present to the physician on the initial encounter to address acute injury/pain and on subsequent encounters for ongoing care, which may be related to the initial injury/pain.
After the decision is made to utilize OMT to treat the diagnosis, the physician begins the preservice work associated with OMT, followed by hands-on manipulation (intraservice) and concluding with the postservice work.
Learn more tips for managing your practice with these on-demand webinars.
Visit the AOA Online Store for more resources focused on helping you navigate the world of billing and coding, including the AOA's Guide to OMT Coding and Documentation.