DOs and MDs Guide to Billing for OMT: OSTEOPATHIC MANIPULATIVE MANAGEMENT

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GUIDELINES FOR CODING OSTEOPATHIC MANIPULATIVE MANAGEMENT


The following is the description of the new OMT codes as published in the 1994 edition of CPT. There are more than 500 new and revised codes in CPT 1994. The CPT Editorial Panel voted to accept the proposal of the AOA to move the osteopathic manipulative treatment codes from the HCPCS alpha-numeric system into CPT. With the advent of these new codes 98925-98929, one should no longer report claims using the M codes or 97260, 97261.

CPT - Codes Procedure Description


98925 - OMT; one to two body regions involved

98926 - OMT; three to four body regions involved

98927 - OMT; five to six body regions involved

98928 - OMT; seven to eight body regions involved

98929 - OMT; nine to ten body regions involved



These codes replace the MC700 series once found in HCFA's Common Procedure Coding System (HCPCS).

Note: For Medicare, the -25 modifier must be attached to the E/M code reported in conjunction with OMT. The entire coding system for evaluation and management (E/M) was changed. The new E/M codes range from 99201 to 99499 and are organized according to site of service, new vs. established patient and the level of care provided. The appropriate code to report is based on key components: history; examination; medical decision making; counseling, coordination of care; nature of presenting problem; and time. The first three components (history, examination and medical decision making) are considered the key components in selecting a level of E/M service.


Appropriate Use of OMT Codes

After the physician evaluates the patient and arrives at a diagnosis, it is allowable to use an evaluation and management (ElM) code in addition to the appropriate OMT code (98925-98929) provided the physician has documented in the patient's record the E/M service provided using the SOAP format. SOAP is an acronym for: Subjective complaints and histories from the patient; Objective findings of the physician's examination and any diagnostic tests performed; Assessment or differential diagnosis based on the first two items; and Plan, which is the recommended course of treatment developed by the physician.

Osteopathic Manipulative Treatment

Osteopathic manipulative treatment is a form of manual treatment applied by a physician to eliminate or alleviate somatic dysfunction and related disorders. This treatment may be accomplished by a variety of techniques. Body regions are defined as head, cervical, thoracic, lumbar, sacrum, lower extremity, upper extremity, pelvis, ribs, abdomen and viscera. (Such regions are defined in ICD-9 codes 739.0-739.9.) This information should be shown on the claim form or in the physician record.


Osteopathic Structural Diagnosis Includes: Somatic Dysfunction (By Region)

739.0 Head Region: Occipitocervical Region

739.1 Cervical Region: Cervicothoracic Region

739.2 Thoracic Region: Thoracolumbar Region

739.3 Lumbar Region: Lumbosacral Region

739.4 Sacral Region: Sacrococcygeal Region, Sacroiliac Region

739.5 Pelvic Region: Hip Region, Pubic Region

739.6 Lower Extremities: Acromioclavicular Region, Sternoclavicular Region

739.7 Upper Extremitiee

739.8 Rib Cage: Costochondral Region, Sternochondral Region, Costovertebral Region

739.9 Abdomen and Other