Osteopathic Billing & Coding

If you’re an AOA member, contact us to receive personal assistance in the areas of documentation, coding and billing compliance, and payment and/or insurer hassles.

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

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The chart below contains the work value for OMT codes 98925-98929:

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 vascular, lymphatic and neural elements. It may be beneficial (but not required) to prepare a separate procedure note detailing which regions were manipulated, the utilization of techniques and how the patient tolerated the treatment.

Documentation tips:

• Always separate your E/M services from the procedure note. Your documentation should identify that a separate and significant E/M was performed the same day as the OMT.
• Always precede OMT with E/M that clinical supports the medical necessity for the services.
• Never bill more than one E/M service per physician per day.
• Never use modifier -59 instead of modifier -25.

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.

• OMT is a manual treatment associated with musculoskeletal pain conditions and/or its effects on other body systems.
• Patients do not present to DOs to solely receive OMT.

Patients typically present to the physician on the initial encounter to address acute problems and on subsequent encounters for re-evaluation and ongoing care, which may be related to the initial problem.

• The E/M service is necessary to address the presenting problem, followed by the physical exam and concluding with medical decision making.
• Once the physician decides to utilize OMT to treat the diagnosis, the three key components of an E/M service have been  met.
• The decision to utilize OMT is typically made on a visit-by-visit basis, requiring the physician to re-evaluate the patient on subsequent encounters to determine if OMT will be beneficial.

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.

• Evaluation and Management Scoring: Michael Warner, DO, discusses how providers can score an evaluation and management service based on documentation.
• Documentation & Coding: What auditors look for: Susan Carbone, MBA, provides tips for improving your practice’s documentation and coding. See slides for more information.
• Is my E/M supported with OMT? Documentation Guidelines: Susan Carbone, MBA, provides the documentation guidelines with examples of what is needed to bill for an E/M visit on the same day as an OMT. See slides for more information.