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CTIV

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I have a good physician friend who is an MD and she would like to start applying some basic OMT techniques for her patients. She has learned some techniques from me teaching her. In order for an MD to be reimbursed, do the insurance companies look for some type of proof that the MD has been to an osteopathic CME course? Or is being taught by another D.O. sufficient? Or does this really depend on the individual insurance companies and the contract negotiated through them? From the reading that I have done, it looks like the general consensus is that MD's can bill for the techniques regardless of formal OMT training, as long as they document correctly. Thanks for any information.
 

group_theory

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It depends on the payor. Your friend needs to contact the major payors that he/she has a contract with and ask about any specific requirements. OMT billing can get a little tricky.

There are numerous CPT codes for various OMT treatments
Medicare itself does not restrict the use of OMT CPT codes to DOs only. Some insurance might. Some insurance will only pay for OMT if the visit was only for OMT and not for visit+OMT (either initial or established visit). Make sure you also teach your MD friend how to properly document evaluation and treatment of the somatic dysfunction.

From the Michigan Osteopathic website:

"The modifier -25 must be used with the E/M service to indicate that the E/M service is a separately, identifiable service from the OMM service. A separate diagnosis is not required for each of the services. The same diagnosis may be reported.

The term "significant, separately identifiable E/M service" is not defined either in Current Procedural Terminology (CPT) or in Medicare guidelines. The AOA's position is that "significant, separately identifiable" means that the physician has documented medically necessary care to the level specified in the E/M documentation guidelines."

and


"Evaluation and Management services may be reported separately if, using the modifier "-25," the patient's condition requires a significant, separately identifiable E/M service, above and beyond the usual preservice and postservice work associated with the procedure. The E/M service may be caused or prompted by the same symptoms or condition for which the OMM service was provided. As such, different diagnoses are not required for the reporting of the OMM and E/M service on the same date.

Body regions referred to are: head region; cervical region; thoracic region; lumbar region; sacral region; pelvic region; lower extremities; upper extremities; rib cage region; abdomen and viscera region.
  • 98925 Osteopathic manipulative treatment (OMM); one to two body regions involved
  • 98926 three to four body regions involved
  • 98927 five to six body regions involved
  • 98928 seven to eight body regions involved
  • 98929 nine to ten body regions involved

Despite the clarity of the AOA and the CPT codebook, regarding charging for OMM and the office visit on the same date of visit, some insurance companies still will not pay for both services. In the insurance companies explanation of benefits (EOB) the reasoning goes something like this; THIS PROCEDURE IS NORMALLY INCLUDED IN THE COST OF THE PRIMARY PROCEDURE. If the claim is not submitted using a modifier 25 than the insurance company probably will not pay. A modifier 25 is necessary regardless of the insurance company for reporting of the OMM and E/M service on the same date. "

http://www.mi-osteopathic.org/pages/physicians/committeepages/omm.html
 

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Agree with above. Its all about the documentation.
 
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group_theory

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Agree with above. Its all about the documentation.

Wow - your post looks like an attending note, especially for surgery ... nice and short

Perhaps if you want to modify it for medicine it could be


JPHazelton said:
I have seen the original post and understood the question. I have read the subsequent response and agree with above.
Plan:
1. Have provider contact insurer(s) to ask about specific policy
2. Educate provider on need for proper documentation
3. Educate billing staff about proper ICD-9 and CPT codes for OMT
4. Sodium is a little low - will plan a 3 hr discussion with housestaff about the differential diagnosis of mild hyponatremia and subsequent fluid management :smuggrin:
 

McDoctor

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Wow - your post looks like an attending note, especially for surgery ... nice and short

Perhaps if you want to modify it for medicine it could be

:laugh:

Classic.

You'd have to add: (assuming AOA-approved institution)
5. OMT performed by OMS3 with my supervision.
 
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