Billing for OMT

[ComicBookHero20]

Just wondering if anyone has any simple explanation of how one bills for OMT

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[munchymanRX]

Just wondering if anyone has any simple explanation of how one bills for OMT

The same way you'd bill for any procedure/treatment. You document what was performed, where it was performed, and why it was performed. Then you submit a request for reimbursement to an insurance company or Medicare/Medicaid (yes, they cover it).

However, the only times I've seen OMT in practice have been at cash-only private practices. I know that this is not the rule, though.

 

[Kuba]

ICD9 codes.. http://omt4fp.tripod.com/links/billing_coding.htm

 

[Shinken]

Just wondering if anyone has any simple explanation of how one bills for OMT

You need both a diagnosis code for a "standard" allopathic-style lesion and then one for "somatic dysfunction" of the same affected area, otherwise most insurances won't pay for it. Then you can bill for OMT as a procedure to treat that somatic dysfunction, and the level of service depends on how many regions you treat.

For example, for low back strain you would report a diagnosis of "lumbar strain" then a diagnosis of "somatic dysfunction, lumbar", then treat. If you treat only the lumbars then you would bill for OMT for 1-3 regions.

 

[Styria]

Also, by billing for the number of regions treated, you don't have to specify in the coding the specific techniques or number of techniques used. If three different techniques didn't work for a stubborn elbow and you have to resort to counterstrain, it's one region. Or if you're using ligamentous articular train and treating cervical and cranial at the same time, that's one technique but two regions billed for.

 

[bones]

Just wondering if anyone has any simple explanation of how one bills for OMT

Its not that complicated once you understand it, though it sounds like a lot to remember at first. You need to do whats called a modifier 25 code so that you can bill for an office visit plus a procedure on the same day- OMT is billed as the procedure.

Its billed much like evaluating someone for knee pain and then giving them a knee injection- same modifier code.
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that was my simple explanation. For those who want more info:

You can expect to be reimbursed by insurance something like $35-$125 for the procedure in addition to your normal office visit code, depending on how many regions you treat (which roughly increases reimbursement for the visit 50-100% for primary care). Depending on how good you are it will probably take you about 50% more time to see the patient, so the pay is proportional to the extra time spent. Not all insurance companies will cover it, but most do and medicare and medicaid do. You need to actually be dealing with a medical condition (though neck pain and lumbar strain are considered medical conditions) and do a real history and physical exam in order to bill for both OMT and a physical exam (and document properly using specific wording)- or insurance might try to only pay you for the procedure without the office visit.

To answer another post in this thread:
The reason so many people do cash practices for OMT is because if you're good you can make bank and cut out all the headaches of dealing with insurance. Put yourself in the patients shoes- if its a choice between a $6k surgery and an OMM doc that charges $300 cash that your neighbor says fixed their similar problem permanently in one or two visits- you might choose the OMM doc. If they were successful in fixing you, you might tell your friends, family and neighbors with similar conditions. That doc would then be fine in a cash practice, and be making about 2-3x as much as his insurance taking colleague once you figure in his reduced administrative and billing costs. I have seen numbers in big cities like $450 for an hour new patient visit or $300 for 40 minute new patient visit, and typically you see half that price for follow up given half the time.

These people have to produce serious results- or nobody would go back for a second visit and referrals would run dry... they'd be out of business in no time. It is a more pressure to perform than a 50cent co-pay, but the rewards are much higher too (grossing upwards of 800k for a 40 hour week, patients treat you like your time is worth hundreds of dollars instead of 50 cents, you don't lose half your gross income in administrative costs, and you never have to deal with insurance companies again!).

You can do a sliding scale for patients that have difficulty paying if you choose and still have many of the above benefits, and you can also let patients with private insurance bill their insurance company for whatever part their insurance is willing to pay (you would have to fill out your usual paperwork with the modifier 25 but the patient deals with submitting the paperwork and waiting the 3 months rather than you in that case- and thus you don't hire billers and your administrative paperwork is still vastly less.


For the average DO, it is probably better to bill insurance for OMT. Using OMT in a standard practice and billing insurance doesn't demand anything beyond what you learn in class and it still allows you to spend more time with patients, tools for pain management other than NSAIDS, muscle relaxers and narcotics- and if you're fast, you might make a little extra overall income on the year while seeing slightly fewer patients overall. Also, hands-on care, fewer patients and spending more time with patients all make it less likely you will be sued. If you want to master OMT, you should consider teaching (you will need to know how to bill) or a cash practice in a big city- two good ways to go- of course there is much more money in the latter, and at least you can teach the students that shadow you.

Good luck!
Bones

 

[bones]

These people have to produce serious results- or nobody would go back for a second visit and referrals would run dry... they'd be out of business in no time.

I hear a few med students saying that they imagine some patients are gullible enough to pay this much for someone only claiming results- or they pay this much just for the attention from a charismatic doc... I suppose this might be possible in a few isolated cases (I haven't seen it in the cash practices I shadowed in my training). I personally wouldn't be able to live with myself conning people... I prefer the hard work and huge intellectual challenge and problem solving involved in doing real osteopathy- and the joy of a cured patient after they have suffered for years. The nice pay is really nothing compared to that- I just talk about money because it is what drives a lot of people- and they feel like they cant do something unless the pay is there so why bother studying it... Seriously though- nothing gets you out of bed in the morning like wondering who's life you're going to change in clinic that day.