DO's billing for OMM

[HarveyCushing]

How would a DO in FP bill for OMM? Would I need to do a DO FP inorder to do this? Could one go to an ACGME residency? Or is just graduating from a DO school and completing a FP residency enough?

---

Members don't see this ad.

 

[HarveyCushing]

Anyone know where I can find an answer to this question?

 

[allendo]

Anyone know where I can find an answer to this question?

there are icd9 codes for non allopathic lesions. I think most allopathic programs are open to omm

 

[McDoctor]

How would a DO in FP bill for OMM? Would I need to do a DO FP inorder to do this? Could one go to an ACGME residency? Or is just graduating from a DO school and completing a FP residency enough?

OMM is billed as a procedure. There are 5 different OMM billing codes, dependent upon the number of body regions manipulated (98925 to 98929). There are specific diagnostic codes for the condition being treated by the procedure, they are term "somatic dysfunction, cervical" (AKA "non-allopathic lesion") or "somatic dysfunction, lumbar"...739._ dependent upon location.

You can add the procedure charge to the charge for the office visit.

For example a patient may present with headache. You take a history with at least 4 elements, do a pertinent review of systems, a focused exam... HEENT, neck, neuro, heart, lungs...Your assessment might be "headache, tension type" and your plan might be OMM.

You would then write a seperate procedure note detailing your findings, the modality of OMT performed, etc.

The bill submitted will be 99213 (E&M) with the ICD-9 code for a headache, with what's called a "modifier 25" (indicates a procedure was done during the visit but as a seperate service) and then submit 98925 (OMT 1-2 regions)with the diagnosis 739.1 (somatic dysfunction cervical).

The 99213 might pay about $65.00. The OMT might give you an additional $25 or so. Many insurers wont pay both in the same visit however.

I don't know if you have to even be a DO or do a DO residency to be "allowed" to bill for this. You will have separate contracts and fee schedules with each payor, and they typically decide who and what they pay for. Medicare reimburses OMT, anywhere between $20 to $50 per procedure code. Concievably, if you were gouging medicare with OMT (hardly possible at those $$ numbers), and didn't have any evidence of board certification in Osteopathic Manipulation or that you lacked sufficient training in the procedure, you could get audited and your claims denied.

I think you could probably get away with it, even doing a ACGME residency, if you took a refresher course.

Hope that helped

 

[HarveyCushing]

I don't know if you have to even be a DO or do a DO residency to be "allowed" to bill for this. You will have separate contracts and fee schedules with each payor, and they typically decide who and what they pay for. Medicare reimburses OMT, anywhere between $20 to $50 per procedure code. Concievably, if you were gouging medicare with OMT (hardly possible at those $$ numbers), and didn't have any evidence of board certification in Osteopathic Manipulation or that you lacked sufficient training in the procedure, you could get audited and your claims denied.

I think you could probably get away with it, even doing a ACGME residency, if you took a refresher course.

Hope that helped

Thanks that is very helpful. Maybe I will also ask one of the FP faculty members what their take on this is.

 

[labruy69]

Any doc can bill for OMT, even MDs. Ethically only those adequately trained should be preforming OMT and only when it is done to help the patient. Also, your documentation must support your billing.
At my program one of the MD's took a weekend OMT for MD's course and now does OMT regularly and bills for it. We teach the MD's basic OMT techniques during several lectures throughout the 3 years and for those MDs interested, we teach them more advanced techniques. Many of the OMT intested MD residents perform OMT on their patients in the office (they do not bill for it, but a few plan to take the course and start billing). The course is not required to bill and these MDs could go out and practice OMT and bill for it. Not sure if Medicare would say anything. I would be worried about defending myself in court in the event a patient wanted to sue for adverse outcomes related to treatment (I know this is extremely rare, but at least plausible, especially if you're not aware of the contraindications to some modalities). My 4 years of training makes me an "expert" in OMT, that weekend course might not hold up so well in court.

 

[sexyman]

The Doc I saw today said that she bills per body region. If she adjusted my neck, back, and hips how much do you think she gets compensated for that?

It was great by the way- I felt like I was floating when I left her office.

 

[DrB]

Thanks for all the above info, it is nice to know we can do more for our patients and for ourselves.

Still, delivering care based on a pt's insurance plan leaves a bad taste in my mouth. I know the best way to practice medicine is to treat all patients the same and to give the care you feel they need, but I know that doesn't always happen. In the FP clinic I was just at we had many Medical/medicare pts as well as cash pay pts and private insurance patients. Our treatment plan had to take these things into account. Routine labs, vaccines, radiology and even sending pts to the ER was based on the type of insurance they carried. Giving OMT to this population was equally strategic; however, it provided a cost effective way to handle chronic conditions in people who would have otherwise suffered.

-B

 

[normalforce]

You get reimburse by region. Roughly medicare/caid pay $40/REGION. So 4 regions (neck, thoracic, lumbar, sacrum/hip) = $320. Have the patient come back after the first visit so that you get reimbursed. Other docs I know do a cash only process. They have a waiting list of 3-6 months and make $200-$300K/ year.

Easy to do if your good at OMM and can treat other basic stuff.

As a PMR doing Spine/Sports/Pain, I will use OMM and bill insurance/medicare.

Good luck.

NF

 

[sexyman]

That is really good actually. I don't understand why more DOs don't take advantage of OMM. I had to go out of my way to ask my doc for OMM- and I would be more then happy to go back for another visit if she suggested it.

Is it seen as "unethical" if a physician asks you if you would like treatment? Does the patient have to come to the office with a particular chief complaint that warrants OMT in order for it to be "justified"?

Because if not I don't see why more DOs dont try and do some type of OMT on every patient.

 

[HarveyCushing]

You get reimburse by region. Roughly medicare/caid pay $40/REGION. So 4 regions (neck, thoracic, lumbar, sacrum/hip) = $320.

How does $40x4=$320? Am I missing something? 😕

 

[McDoctor]

You get reimburse by region. Roughly medicare/caid pay $40/REGION. So 4 regions (neck, thoracic, lumbar, sacrum/hip) = $320. Have the patient come back after the first visit so that you get reimbursed. Other docs I know do a cash only process. They have a waiting list of 3-6 months and make $200-$300K/ year.

Easy to do if your good at OMM and can treat other basic stuff.

As a PMR doing Spine/Sports/Pain, I will use OMM and bill insurance/medicare.

Good luck.

NF

I've looked into this, and medicare pays about $20 to $25 for OMT 1-2 regions, and $50 to $55 for OMT 9-10 regions. I can provide a link if you'd like. I also look at our offices reimbursements. I've never seen private payors reimburse more than $50.

You can charge as much as you'd like. As far as getting reimbursed, your numbers seem inflated. Do you have a source for this?

 

[McDoctor]

That is really good actually. I don't understand why more DOs don't take advantage of OMM. I had to go out of my way to ask my doc for OMM- and I would be more then happy to go back for another visit if she suggested it.

Is it seen as "unethical" if a physician asks you if you would like treatment? Does the patient have to come to the office with a particular chief complaint that warrants OMT in order for it to be "justified"?

Because if not I don't see why more DOs dont try and do some type of OMT on every patient.

OMT is a medical procedure. I think if you look to do a medical procedure on every patient, regardless of the underlying diagnosis, just for the sake of doing a procedure then yeah...that's unethical. I think it should be taken seriously and applied judiciously to certain medical conditions.

If you like fishing for reasons to do excessive procedures, I'd suggest interventional cardiology or gastroenterology.

 

[sexyman]

I don't think it is necessarily fishing. DOs supposedly place extra emphasis on preventative medicine. Why would correcting somatic dysfunctions before they start giving you pain be unethical?

 

[McDoctor]

I don't think it is necessarily fishing. DOs supposedly place extra emphasis on preventative medicine. Why would correcting somatic dysfunctions before they start giving you pain be unethical?

I don't think I'd use the word unethical if the physician truly felt he/she were helping the patient. But the thought process that states that "somatic dysfunctions" need corrected before they cause pain is flawed. And there is a financial motive to doing excessive procedures that is hard to ignore. Should we stent coronary arteries before they become blocked?

There should be some proof of benefit before we broadly apply certain medical treatments. Just because a certain treatment may help an individual with a medical condition (generalized pain, in this case), that doesn't mean we should apply the same treatment to an otherwise healthy person (someone without generalized pain).

This is the same line of thinking that leads doctors to over prescribe statins for otherwise healthy, low risk individuals...taking a treatment that works for people with certain conditions and just assuming they will be beneficial for preventing the same condition in low risk populations. But this approach ignores the potential harms. Just as nobody knows what the effects of 25 to 30 years of a statin might be on liver function, muscle function, cognitive function, nobody knows what the long term effects of 25 to 30 years of regualr spinal manipulation might be. Maybe you accelerate arthritic conditions. How would you know?

And contributing to excessive health care costs is harmful in itself. If you provide excessive care to healthy people who can afford insurance but don't really need medical care, then you are harming those people with real medical problems who can't afford insurance.

 

[George85]

Keeping current with OMM during residency may be an issue. At my ACGME program there are 2 DO's on faculty and 5/18 residents are DO's, but the residents are unable to bill for OMM even if the preceptor for the day is one of the DO's.

 

[oxytocin]

How would one transition from billing insurance to collecting cash? has anyone tried this? how many patients actually stay around?

 

[JaggerPlate]

How would one transition from billing insurance to collecting cash? has anyone tried this? how many patients actually stay around?

Lots of people always talk about the cash based OMM practices or people who started insurance and transitioned ... but it just seems like these docs aren't on SDN. I searched pretty well a few months ago and found lots of threads with people who knew docs, or went to a school where the OMM head was an ex cash practice doc, etc, but didn't really find any threads where someone said 'I'm an OMM cash doc, and do X and Y.' Maybe someone will chime into this thread because I find the business side of OMM practices fascinating.