Putting it Together: Coding

00:01 So putting it all together.

00:03 So here, we have a patient that came in with a complaint of headache and so because of their presentation, we perform an evaluation and decided on it's management.

00:14 So, have an E/M code of a 99213 for an established patient of modern complexity.

00:22 So we performed an evaluation and decided to manage the patient for their headache so we took a thorough history, we ruled out any sinister pathology for headache, we performed the physical exam, we checked their vital signs and based on all of our history and physical exam, we then decided that we should integrate OMT.

00:41 And so, OMT is a procedure, we decided that there were 4 areas that corresponded that may be contributing to the headache that we performed OMT on.

00:52 And so we bill the procedure code on top of the evaluation and management.

00:58 So when we have a procedure linked with evaluation and management code the same day, we have to use a 25 modifier to signal to the billing company, to the insurance companies, that we did that, we had a evaluation and management and based on our evaluation and management, we needed to do a procedure linked with it on the same day.

01:20 So the 25 modifier is a code that we use to signify that there was a separate identifiable E/M service by the physician on the day of the procedure.

01:32 So, it's important to document carefully to make sure that this modifier could be used.

01:38 So within your note, you have to show an evaluation and management portion.

01:42 So there should be a thorough history, there should be a physical exam with vitals and then from that, a complexity of care could be derived.

01:51 OMT is a separate and disctinct procedure that was indicated after proper evaluation and management of the patient.

01:59 So in our case, the patient came in, had a headache, we gather the history, did a physical exam and then decided to apply the procedure of OMT to treat their headache.

02:10 So our OMM CPT codes are the codes that we utilize to bill for the OMT procedure.

02:17 This is gonna be based on the number of body areas that you treat.

02:21 And so, if we treat more regions, then we would be billing a different code.

02:26 The higher number of regions you treat, the higher the reimbursement.

02:31 And so if we treat 1 to 2 areas, this is gonna be a 98925 and so forth.

02:36 So based on the number of regions that you treat, you'll bill the corresponding CPT code.

02:43 So, key pointers to remember.

02:45 Report an E/M service with a modifier 25 and OMT if performed on the same day.

02:51 Ensure that you have thoroughly documented the history, chief complaint, onset, frequency, the OPQRST of the story, document specific somatic dysfunctions that you find and detail the regions that you treated with OMT.

03:06 Include all the techniques you used and describe how the patient tolerated the treatment.

03:11 There's some additional factors that you should take into consideration for possible reasons for denying OMT claims.

03:18 There is a red flag that is raised sometimes when patients have repetitive treatment especially for chronic patients, chronic conditions, for more than 6 months that has deemed to be maintenance care.

03:31 If there is failure to document functional improvement or decline especially in patients seen repeatedly over an extended period of time, you want to make sure that you are documenting important functional gains of improvement, such as decrease in pain medication, increase exercise or ambulatory tolerance, able to walk further additional 5 blocks, able to sit for longer, able to perform their ADL's.

03:57 And so, you want to be able to document how the patient is improving with the procedures.

04:03 Try to avoid putting in a note, "Patient here for OMM or for follow up OMM" because that then negates to your evaluation and management.

04:11 So really the patient's here for back pain or headache and you evaluate them and then you needed to apply OMT.

04:20 There are resources out there to assist and help if you have issues with billing, issues with the billing company or the insurance company with reimbursement.

04:30 So take advantage of those different resources that are out there to help physicians with their reimbursement.

04:36 Hopefully, with proper documentation and understanding the billing and coding of OMT, you'll be able to apply these and help you with getting reimbursed for the procedures that you are doing.