Osteopathic Manipulative Medicine and EM Modifier 25
780 بار بازدید -
5 سال پیش
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Coach Jennifer: yeah. We had
Coach Jennifer: yeah. We had somebody come in with a question about osteopathic manipulative medicine and then the E/M. Or if you look it up in the CPT manual you’re going to look under osteopathic manipulative treatment. It’s meaning the same thing but people use different terms, we see that a lot in learning this people know a lot of different terms for things that we don’t.
Q: More than just the use of Modifier 25, but the medical necessity for billing an EM code when the patient is being treated for low back pain and the decision is to perform OMM.
A: First, some of you are probably wondering “what is osteopathic manipulative medicine”? Medical providers are going to do a manual therapeutic application pressure or they say “force” into a body area. It’s not chiropractic, a lot of people think that that’s chiropractic use specific modalities, specific procedures just like occupational therapist and physical therapist use; so it’s similar. But this we’re looking at typically a DO, an osteopathic doctor is going to do these kinds of treatments typically. There are other people qualified to do this as well.
It’s also called osteopathic manipulative treatment. It’s treatment used on the structural and functional issues that somebody is having with bones, joints, muscles, tendons, tissues. A specific area in the body and what they’re trying to do is restore that function between the neuromuscular system and the whole rest of the body because this we know a lot of times if we have one area that’s bothering you, the rest of the body kind of compensates for it, so it can mess up your whole chi, messes up your whole flow of everything there, and it’s meant to achieve and maintain health of the whole body. That’s what they’re looking at is a whole body health, not just you go to a doctor because your back hurts. They’re not just trying to help your back, they’re trying to influence that area of your back so the whole rest of your body can function as well especially coming from orthopedics, people with back pain really had a problem, a lot of other problems as well.
So this type of treatment is used for all different kinds of illnesses by looking at arthritis, headaches, stress injuries, pain in your back, your shoulders, your knees; so this treatment is the decision of the provider after they do the evaluation and management so they’re going to follow all three steps of the E/M process. They’re going to do your HPI. They’re going to do the exam.
Then, their medical decision making process, they say, “You know what. This treatment really is going to help the rest of your body for this problem that you have.” They do that on a case by case, so visit by visit, it’s not something typically like in the area I deal with all the time, “Well, come back next time, if it’s still bothering you we’ll give you an injection.”
This is kind of the “I really think this is going to help you today. Maybe next time you’ll be better but this is what we’re looking at.”
The codes we’re specifically dealing with in CPT is just one small range of codes: 98925 - 98929. They’re in the medicine section so you’re dealing with the different regions of the body. So you will only ever be billing one code per date of service; it depends on how many body regions you did. So you’re not going to bill 98925 twice or times 2 or times 3 or times 4, you’re going to bill for however many body regions they did and only ever going to bill that one code. When we’re looking at, you’re wondering, “OK, we got 10 body regions, what are they?” Those are described in our ICD-10 codes. So, we’re looking at a segmental or somatic dysfunction. That’s what they’re looking for: somatic dysfunction. The head is one region, cervical, thoracic, lumbar, sacral, and pelvic. Lower extremities, something affecting all of the lower extremities, all of the upper extremities. Your rib cage or the abdomen or other regions; so those are up to your 10 areas that they’re looking for, that they’re going to do. You have a somatic dysfunction and then they’re going to manipulate that area.
Q: More than just the use of Modifier 25, but the medical necessity for billing an EM code when the patient is being treated for low back pain and the decision is to perform OMM.
A: First, some of you are probably wondering “what is osteopathic manipulative medicine”? Medical providers are going to do a manual therapeutic application pressure or they say “force” into a body area. It’s not chiropractic, a lot of people think that that’s chiropractic use specific modalities, specific procedures just like occupational therapist and physical therapist use; so it’s similar. But this we’re looking at typically a DO, an osteopathic doctor is going to do these kinds of treatments typically. There are other people qualified to do this as well.
It’s also called osteopathic manipulative treatment. It’s treatment used on the structural and functional issues that somebody is having with bones, joints, muscles, tendons, tissues. A specific area in the body and what they’re trying to do is restore that function between the neuromuscular system and the whole rest of the body because this we know a lot of times if we have one area that’s bothering you, the rest of the body kind of compensates for it, so it can mess up your whole chi, messes up your whole flow of everything there, and it’s meant to achieve and maintain health of the whole body. That’s what they’re looking at is a whole body health, not just you go to a doctor because your back hurts. They’re not just trying to help your back, they’re trying to influence that area of your back so the whole rest of your body can function as well especially coming from orthopedics, people with back pain really had a problem, a lot of other problems as well.
So this type of treatment is used for all different kinds of illnesses by looking at arthritis, headaches, stress injuries, pain in your back, your shoulders, your knees; so this treatment is the decision of the provider after they do the evaluation and management so they’re going to follow all three steps of the E/M process. They’re going to do your HPI. They’re going to do the exam.
Then, their medical decision making process, they say, “You know what. This treatment really is going to help the rest of your body for this problem that you have.” They do that on a case by case, so visit by visit, it’s not something typically like in the area I deal with all the time, “Well, come back next time, if it’s still bothering you we’ll give you an injection.”
This is kind of the “I really think this is going to help you today. Maybe next time you’ll be better but this is what we’re looking at.”
The codes we’re specifically dealing with in CPT is just one small range of codes: 98925 - 98929. They’re in the medicine section so you’re dealing with the different regions of the body. So you will only ever be billing one code per date of service; it depends on how many body regions you did. So you’re not going to bill 98925 twice or times 2 or times 3 or times 4, you’re going to bill for however many body regions they did and only ever going to bill that one code. When we’re looking at, you’re wondering, “OK, we got 10 body regions, what are they?” Those are described in our ICD-10 codes. So, we’re looking at a segmental or somatic dysfunction. That’s what they’re looking for: somatic dysfunction. The head is one region, cervical, thoracic, lumbar, sacral, and pelvic. Lower extremities, something affecting all of the lower extremities, all of the upper extremities. Your rib cage or the abdomen or other regions; so those are up to your 10 areas that they’re looking for, that they’re going to do. You have a somatic dysfunction and then they’re going to manipulate that area.
5 سال پیش
در تاریخ 1398/08/21 منتشر شده
است.
780
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