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Billing & Coding

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The key to billing for OMT is to include the -25 modifier onto your E&M code.  This allows you to bill for a separate procedure in addition to the bill for the office visit.  OMT should be thought of as the Osteopathic Family Doctor's procedure.

 

The -25 Modifier

    - For a separate service on the same day

    - Patient seen for "headache" 

    - Diagnosis muscle tension type HA, Cervical Somatic Dysfunction

    - E&M: 99213-25, 98925

    - ICD-9 codes: 307.81 (HA), 739.1 (C-SD)

 

 

Office Visit Codes (CPT Codes)

codes are based on the level of complexity of the visit.

New Patient         Established Patient

  -99201                        -99211               

  -99202                        -99212

  -99203                        -99213

  -99204                        -99214

  -99205                        -99215

 

OMT Codes

based on the number of areas treated

98925  1-2 areas treated

98926  3-4 areas treated

98927  5-6 areas treated

98928  7-8 areas treated

98929  9-10 areas treated

    *10 areas are: cranial, cervical, thoracic, lumbar, sacral, innominate, upper extremity, lower extremity, rib cage, visceral

 

ICD-9 Codes for Somatic Dysfunction

these codes are used as your diagnosis code

739.0 Head/Cranial Somatic Dysfunction (SD)

739.1 Cervical SD

739.2 Thoracic SD

739.3 Lumbar SD

739.4 Sacral SD

739.5 Innominate SD

739.6 Lower Extremity SD

739.7 Upper Extremity SD

739.8 Rib SD

739.9 Abdominal/Visceral SD

 

 

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