1. Making Money with OMT
Review of Billing and Coding Office visits with OMT
Presenter: Sarah James, DO

2. Disclosures
I have no corporate or pharmaceutical sponsorship

3. Objectives
Review general guidelines for documentation, billing and coding for outpatient E/M visits
Discuss procedural cost for preforming OMT
Review specific scenarios when OMT is utilized and how to confidently document, bill and code for it
Practice applying new our refreshed knowledge to actual cases

4. E/M Service Coding Patient type Setting of service
Level of E/M service performed.

5. Patient type Patient Type Setting of Service New Establish
Office, other outpatient setting
Hospital inpatient
Emergency Dept
Nursing facility

6. Level of E/M Service Provided
Three key components
History
Chief Complaint
Location, Duration, Quality, Severity, Timing, Context, Modifying factors, Associated Symptoms
ROS-pertinent, extended, complete
PFSH-Past, Family, and social history
Physical Exam-focused or detailed
Medical Decision Making-straight forward, minimal complexity, moderate complexity, High Complexity

7. Documentation Basics
For any level for an ESTABLISHED patient you need two out of three levels met

8. History For Established Patient
Level 3 (99213): needs 2+ components plus 1 ROS no PSFH
Level 4 (99214): needs 4+ components, plus 2 ROS, PLUS one PSFH

9. Exam for Establish Patient
Level 3 (99213) needs 2+ components
Level 4 (99214) needs 5+ components or one DETAILED exam +2 other systems

10. Medical Decision Making for Establish Patient
Level 3 (99213) needs minimal
Level 4 (99214) needs moderate

11. The Key is:
Documentation

12. OMT Procedure Documentation
Step 1) Document physical exam findings and osteopathic findings(somatic dysfunctions) in your note
You must have documentation of the somatic dysfunctions found in each body region that you are treating.
There are 10 possible body regions.
Regions are: Head, cervical spine, thoracic spine, lumbar spine, sacrum, pelvis, upper extremity, lower extremity, ribs, and abdomen/other
ex) Body Region, Somatic dysfunction  C spine: Hypertonic PSM and trapezius bilat:, Pelvis: left innominate restriction:,Lower extremity:  Hypertonic quads and psoas bilat

13. OMT Procedure Documentation
Step 2) Use allopathic diagnosis a your “primary” diagnosis code(s)
ex) cervicalgia, tension headache, lumbago, sinusitis, and/or hip pain
Step 3) Then add the regions that you treated (this is correlated directly with the somatic dysfunction documentation in your note)
M99.00 Segmental and somatic dysfunction of head
M99.01 Segmental and somatic dysfunction of cervical region
M99.02 Segmental and somatic dysfunction of thoracic region
M99.03 Segmental and somatic dysfunction of lumbar region
M99.04 Segmental and somatic dysfunction of sacral region
M99.05 Segmental and somatic dysfunction of pelvic region
M99.06 Segmental and somatic dysfunction of upper extremity
M99.07 Segmental and somatic dysfunction of lower extremity
M99.08 Segmental and somatic dysfunction of rib cage
M99.09 Segmental and somatic dysfunction of abdomen and other regions

15. OMT Billing and Coding
Step 4) Bill for the appropriate level of service
Most often will be (level 3) or (level 4)
Step 5) Add the appropriate billing code for the number of regions you treated
regions $32.42
regions $42.95
regions $55.82
regions $65.09
regions $75.12

17. Can I bill for OV with scheduled OMT?
Yep!
Must evaluate the need for OMT and what SD is now present=should ALWAYS be able to get a Level 3 established patient OV
BUT, often you should use a Level 4 established OV if the problem is acute on chronic or new problem

18. What does OMT pay? 98925 1-2 regions $32.42 98926 3-4 regions $42.95

19. How much money are we talkin’?
body regions= $32.27
Average full time pt/day=18
Treat 3 pts with 98925(plus OV)/day= ~$100
4 days in clinic/week= $400, $1600/month
46 week year=$18,400
Treat 4 pts/day x 5 days/wk x46 wks=$29,440

20. ICD-10!
ICD-10-CM/PCS is a replacement for ICD-9-CM diagnosis and procedure codes.
The implementation of ICD-10-CM/PCS will not impact the use of CPT and alpha-numeric Healthcare Common Procedure Coding System codes.

21. Case 1-Lets practice
What level of service is this history?

22. Case 1
Level 4
Has at least 4 HPI elements, 2-5 ROS, and 1 PFSH

23. Case 1
What Level of service is this exam?

24. Case 1
Level 4
Has at least 5 systems

25. Case 1
What Level is this decision making?

26. Case 1
Moderate—Level 4
Advised on medication use/discontinue, labs for other possible causes of patient’s symptoms that are not clearly defined

27. Summary of Case 1 History-Level 4 Exam-Level 4
Medical Decision making-Moderate=Level 4
Establish patient: Only need 2 of 3 to achieve level of service Level 4 (99214)

28. Case 2-History

29. Case 2-History
Level 4
Has at least 4 HPI elements, 2-5 ROS, and 1 PFSH

30. Case 2-Exam

31. Case 2-Exam
Level 4
Has at least one detailed exam and 2 others

32. Case 2- with OMT

33. Case 2-Decision Making Level 3 or 4
Minimal to moderate due to adjustment of Lyrica

34. OMT Procedure
Treated 10 of 10 possible body regions

35. Summary of Case 2 History- Level 4 Exam- Level 4
Medical Decision Making- Level 3-4
2 of 3 met=Level 4 (99214)
PLUS OMT procedure, add -25 modifier
With

36. Case 3
S: Nursing notes reviewed. Aleah Harris is a 5 year old female who presents with a 1 day(s) history of left - ear pain. Dull ache. No drainage out of the ear. Associated upper respiratory symptoms: cough, rhinorrhea and fever up to for 3 days. Ibuprofen and tylenol alternating daily. Has not had any medicine today. Is behaving normally today. Over the weekend was more lethargic and took a naps which is unusual. Past history of ear problems: episodic past otitis media and last time was in January 2014.

37. Case 3-History
Level

38. Case 3-Exam
BP 100/52[ped's cuff, rt arm[, Pulse 128, Temp °F (38.8 °C), Temp Src: Oral, Resp 30, Ht 3' 8.5" (1.13 m), Wt 48 lb ( kg),
Ears: Right: External - normal Canal - nonerythematous TM - nonerythematous, cone of light intact
Left: External - normal Canal - nonerythematous TM - intact erythema, dullness, behind TM purulent fluid
Nose/Sinuses: clear rhinorrhea, edematous turbinates
Oropharynx: no erythema or exudate
Neck: anterior cervical nodes - bilateral
Lungs: clear to auscultation

39. Case 3-Exam
Level

40. Case 3-Medical Decision Making
A/P AOM- Ceftin for 10 days. OMT, mother verbally consented
Discussed home care and OTC medications for symptomatic relief.
Recheck as needed for persistent, worsening, or new symptoms

41. Case 3-Exam
Level

42. OMT Documentation Cranial: Left internally rotated temporal bone
Cervical: OA-ERrSl, hypertonic PSM
Sacrum: Bilat sacral flexion
Treatment: Cranial, ME, MFR, and Soft Tissue
Patient tolerated procedure, symptoms improved, and somatic dysfunction improved.

43. Case 3 What DX do you document? 1-AOM (primary)
2-Nonallopathic somatic dysfunction of Head
3-Nonallopathic somatic dysfunction of Cervical
4-Nonallopathic somatic dysfunction of Sacrum

44. How do I add OMT to Office Visit?
Bill for your level 3, 4, or 5 OV, PLUS regions treated with -25 modifier.

45. Case 3-Summary
History
Exam
Medical Decision Making
OMT

46. Case 4-History

47. Case 4-Exam

48. Case 4- Medical Decision Making

49. Questions?
Hope this was helpful

50. References
Waller, T MD;Level II vs Level III Visits: Cracking the Codes.Fam Pract Manag Jan;14(1):21-25.