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Osteopathic Manipulation Therapy Coding Fact Sheet

 

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Coding for Osteopathic Manipulative Treatment

Osteopathic manipulative treatment (OMT) is a form of manual treatment applied by a physician or other qualified health care professional1 to eliminate or alleviate somatic dysfunction and related disorders. This treatment may be accomplished by a variety of over 20 different manual treatment techniques.

OMT Services:

  • May be reported in addition to significant and separately identifiable E/M services such as:
    • New or established patient office or other outpatient services (99201-99215), hospital observation care (99217-99220,99224-99226), hospital care (99221-99223, 99231-99233), critical care services (99291, 99292), observation or inpatient care services (99234-99236), office or other outpatient consultations (99241-99245), emergency department services (99281-99285), nursing facility services (99304-99318), domiciliary, rest home, or custodial care services (99324-99337), and home services (99341-99350)
  • Requires the use of modifier 25 on the significant and separately identifiable E/M service reported in addition to the OMT code
  • Do not require a different diagnosis for the reporting of the OMT and E/M service on the same date.

Body regions referred to are:

 

​Head regionSacral region
​Cervical regionPelvic region
Thoracic regionLower extremities (bilateral is one region)
​Abdomen / viscera regionUpper extremities (bilateral is one region)
Lumbar regionRib cage region

OMT CPT/HCPCS Codes:
98925​Osteopathic manipulative treatment (OMT); 1-2 body regions involved
98926​3-4 body regions involved
98927​5-6 body regions involved
​98928​7-8 body regions involved
98929​9-10 body regions involved
S8990​Physical or manipulative therapy performed for maintenance rather than restoration

Maintenance therapy occurs after the goals of the treatment plan have been reached, the therapy is no longer of therapeutic necessity, and it is apparent that no additional functional improvement is occurring or expected to occur. Maintenance therapy is performed to maintain the quality of life, disease prevention, and general health maintenance.

Frequently Asked Questions

What specific types of injuries/illnesses are treated by OMT?
OMT is typically used to treat low back pain, musculoskeletal abnormalities, and somatic dysfunctions, in addition to other illnesses and injuries.

What is the definition of "somatic dysfunction?"
CPT codes 98925-98929 describe osteopathic manipulative treatment, defined as a form of manual treatment applied by a physician to eliminate or alleviate somatic dysfunction and related disorders. The term "somatic dysfunction" is used to designate impaired or altered function of related components of the somatic (body framework) system, skeletal, arthrodial and myofascial structures, and related vascular, lymphatic, and neural elements.

When reporting OMT, is it appropriate to report these codes based on the number of lesions treated? For example, if three lesions are treated in the neck region, how would that be reported? 
The codes for OMT are reported based on the number of body regions involved and not on the number of lesions in a particular body region. Therefore, if three lesions are treated in the cervical region (ie, one region), the service would be reported with CPT code 98925, which indicates one to two body regions involved.

Who may report OMT?
From a CPT coding perspective, it is important to recognize that the listing of a service or procedure and its code number in a specific section of the CPT codebook does not restrict its use to a specific specialty group. Any procedural service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care professional. Therefore, OMT may be reported by any qualified health care professional as allowed by the appropriate state licensure and/or institutional regulations.

What should be documented in order to support OMT?

  • Ensure that you have thoroughly documented the history of the chief complaint, onset, frequency, duration, etc
  • Document somatic dysfunction
  • Detail the regions treated with OMT (to support the CPT codes reported)
  • Include all of the techniques used and describe how the patient tolerated the treatment
  • Functional improvement or decline, especially in patients seen repeatedly over an extended period of time

Reported Diagnosis and Corresponding ICD-10-CM codes

  • Use as many diagnosis codes that apply to document the patient’s complexity and report the patient’s symptoms and/or adverse environmental circumstances.
  • Once a definitive diagnosis is established, report the appropriate definitive diagnosis code(s) as the primary code, plus any other symptoms that the patient is exhibiting as secondary diagnoses that are not part of the usual disease course or are considered incidental.
  • ICD-10-CM codes became valid on October 1, 2015
M99.00​Segmental and somatic dysfunction of head region
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 lower extremity
​M99.07​Segmental and somatic dysfunction of upper extremity
M99.08​Segmental and somatic dysfunction of rib cage
M99.09​Segmental and somatic dysfunction of abdomen and other regions

Vignettes
#1

4 y/o new patient presents with 6 months of bilateral recurrent suppurative otitis media.  Mom wants to avoid myringotomy tubes.  ENT consult 3 weeks ago and considering tube placement.  Per mom hears fine and no issues at preschool. The ENT exam revealed normal EACs and fluid behind the tympanic membrane's. Exam also revealed right subocciptial congestion with externally rotated right temporal bone.  OAERRSL. C2RR C6-T2ERSL with poor CT junction ROM.  T9-L2NRLSR.  Right sacroiliac congestion and right lower extremity externally rotated.

Assessment:

  1. Somatic Dysfunctions as noted above
  2. Chronic AS OM - bilateral
  3. Eustachian Tube Dysfunction - bilateral

Plan:

  1. Myofascial release and osteopathy in the cranial field applied and recheck of AS TM revealed normalization. 98928 (7-8 areas)
  2. Discussed treatment options and wanted to try osteopathic manipulative work.  I see no need for acute imaging and will keep ENT abreast of progress.  Would have her f/u in 2-3 weeks or sooner prn and will set her up for formal audiology evaluation so we can monitor progress.  Speaks well with good phonation so no developmental delays noted.  Will cc primary as well.

Coding:

​ICD-10-CM​CPT
​M99.00; M99.05; M99.06; H66.006  (acute suppurative otitis media w/o rupture of ear drum, recurrent, bilateral;  H69.83   (other specified disorders of Eustachian tube, bilateral)99203  25
M99.00; M99.05; M99.06;98926 (3 body regions – head, pelvic and lower extremities)

#2
15 yo c/o shoulder and hip pain. Playing football Thursday night and was hit on the right hip and landed on his left shoulder. Athletic trainer check him out and had him ice, but hurts to move his shoulder and has some sharp pain over the SI area. Ice and ibuprofen helped a little.  He wanted to ‘work it out’ but his mother insisted he be evaluated.

Soc: High school sophomore. Denies smoking or sexual activity.
PMH: Negative
ROS: Denies weakness, radicular pain and no LOC or vertigo or visual changes after he was hit.
PE: WDWM in NAD
Neuro: DTR +2/4 C5-7 and L4/S1; negative straight leg raising
Skin: No ecchymoses
Ext: Very tight b/l hamstrings.
MSK: Right SI tenderness with locking.  Reduced cervical ROM to the right.  Right anterior innominate, RLE externally rotated and elongated.  Right on right sacral torsion with right SI tenderness on palpation and right paralumbar strain. T10-L2 NRRSL & T3-6 NRLSR with ribs held in inhalation correlative to the rotation found in the thorax. C5-T1FRSL C3ERSL C2RL

Assessment:

  1. Somatic Dysfunctions as noted above
  2. Hip Pain
  3. Shoulder Pain
  4. Sacroiliac Sprain
  5. Cervical Strain, Acute

Plan:

  1. HVLA, MET, MFR utilized with good mobilization and increased ROM.
  2. Responded well to treatment with near resolution of pain.  May return to practice and needs to see the athletic trainer for stretching after hydrocollator packs at least 30 minutes before practice. No need for acute imaging and if this persists his mom is to call to get back in to see me. May consider a muscle relaxant if the cervical strain persists, but the trainer should be able to get most of it gone. Must work on hamstring flexibility. Patient and mom amenable.

Coding:

ICD-10-CMCPT
M99.02; M99.03; M99.01;  M99.05; S33.6XX- (sprain of sacroiliac joint); S13.4XX- (sprain cervical spine)99214 25
M99.02; M99.03; M99.01;  M99.0598926 (4 body regions – thoracic, lumbar, cervical, pelvic)​

 

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