Reader's Question: How to bill for Osteopathic Manipulative Treatment and E/M Performed on the Same Day
When billing for an E/M (evaluation and management) service that includes osteopathic manipulation therapy (OMT), there are a few important considerations to keep in mind.
First, the E/M service must meet the criteria for the selected level of service, based on the documentation of the history, examination, and medical decision making. This may be an office visit, hospital visit, or other E/M service.
Second, the OMT performed must be medically necessary and documented in the medical record. The OMT should be specifically described in the documentation, including the technique(s) used, the location(s) treated, and the response to the treatment.
When billing for an E/M service with OMT, there are a few different codes that may be used, depending on the circumstances. The following codes may be used:
99201-99215 for office or other outpatient E/M services
99221-99239 for initial hospital care, subsequent hospital care, or observation care E/M services
99241-99255 for consultations E/M services
In addition to the E/M code, the appropriate CPT code for the OMT performed should also be reported. These codes include:
98925 for OMT of one to two body regions
98926 for OMT of three to four body regions
98927 for OMT of five or more body regions
The E/M code and OMT code should be reported on the same claim form, with the appropriate modifiers appended to indicate that they are separate and distinct services. Modifier 25 should be used with the E/M code to indicate that the E/M service was a significant and separately identifiable service from the OMT. Modifier 59 should be used with the OMT code to indicate that it was a separate and distinct service from the E/M.
It is important to review the payer's specific coding and billing guidelines to ensure compliance with their policies. The Centers for Medicare & Medicaid Services (CMS) has also published guidelines on the appropriate use of modifiers and the proper billing of E/M services with OMT.
Source: American Osteopathic Association. Billing and Coding for Osteopathic Manipulative Treatment. 2019. CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 12 (available on the CMS website).
ABOUT THE AUTHOR:
Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.