Karen T. Snider, Douglas J. Jorgensen. Billing and Coding for Osteopathic Manipulative Treatment. J Am Osteopath Assoc 2009;109(8):409–413. doi: 10.7556/jaoa.2009.109.8.409.
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Some osteopathic physicians are not properly reimbursed by insurance companies after providing osteopathic manipulative treatment (OMT) to their patients. Common problems associated with lack of reimbursements include insurers bundling OMT with the standard evaluation and management service and confusing OMT with chiropractic manipulative treatment or physical therapy services. The authors suggest methods of appeal for denied reimbursement claims that will also prevent future payment denials.
-25 Significant, Separately Identifiable E/M [evaluation and management] Service by the Same Physician on the Same Day of the Procedure or Other Service: The physician may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M service on the same date [italics added]. This circumstance may be reported by adding the modifier -25 to the appropriate level of E/M service, or the separate five digit modifier 09925 may be used.
Evaluation and Management services may be reported separately if, using modifier 25, the patient's condition requires a significant separately identifiable E/M service, above and beyond the other service provided or beyond the usual preservice and postservice associated with the procedure that was performed. The E/M service may be caused by or prompted by the same symptoms or condition for which the OMT service was provided, as such, different diagnoses are not required for reporting of the OMT and E/M service on the same date [italics added].
Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment.
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