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Demystifying Documentation and Billing for Osteopathic Manipulative Treatment

Journal: Family Practice Management Date: 2021/05, 28(3):Pages: 18-22, type of study: article

Full text    (https://www.aafp.org/fpm/2021/0500/p18.html)

Keywords:

osteopathic manipulative treatment [2973]
OMT [2951]
billing [4]
USA [1086]
article [2076]

Abstract:

Osteopathic manipulative treatment (OMT) is a procedure used mainly by doctors of osteopathic medicine (DOs) for a range of medical conditions. For instance, there's evidence OMT can decrease pain and analgesic use in patients with chronic low-back pain and pregnancy-related low-back pain, can ease postoperative gastrointestinal issues, and may improve outcomes for elderly patients hospitalized with pneumonia.1–4 Because of the commonality of these conditions, and others for which OMT is indicated, some allopathic physicians (MDs) have also sought training in this skill. But there is often confusion about how the procedure should be billed and reimbursed, particularly among physicians who are new to it. Institutional coding and compliance departments have used surgical compliance codes to determine that OMT has a surgical code of zero, which is considered a minor procedure. That means it can be billed the same day as an evaluation and management (E/M) office visit. But Centers for Medicare & Medicaid Services (CMS) guidelines for precepting procedures indicate that a minor procedure takes less than five minutes. It always takes longer than five minutes to do an evaluation and OMT treatment (though there does not need to be long-term follow-up as part of a global encounter as in other surgical procedures), so this gets complicated. Insurance companies often inappropriately bundle the OMT code with the E/M service or eliminate the E/M code altogether.5 Not receiving appropriate reimbursement for OMT could lead physicians to no longer offer this beneficial service to their patients. That would be unfortunate, in part because OMT could be an alternative to opioids for chronic pain, reducing the billions of dollars that opioid misuse costs the U.S. economy every year. This article seeks to cut through the confusion and clarify documentation and billing requirements for OMT so more patients and health systems can benefit from it.


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