OMT Codes

Richard A. Feely, D.O., FAAO, FCA, FAAMA

Coding

The CPT Editorial Panel ruled to include OMT codes starting in the 1994 edition of the CPT Manual. (All Physicians Current Procedural Terminology [CPT] five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines, and other material are copyright American Medical Association.)

Osteopathic manipulative treatment is a form of manual treatment applied by a physician to eliminate or alleviate somatic dysfunction and related disorders. This treatment may be accomplished by a variety of techniques.

Body regions are defined as head, cervical, thoracic, lumbar, sacrum, lower extremity, upper extremity, pelvis, ribs, abdomen and viscera. (Such regions are defined in ICD-9-CM codes 739.0-739.9. This information should be shown on the claim form or in the physician record.

The physician, insurance companies, Medicare, Medicaid, workers compensation and all other third party reimbursement systems need to know the following:

• These codes are to be used by physicians for osteopathic manipulative treatments as of January 1, 1994. It is important that all carriers, claims examiners and physicians be educated on the use of these codes so that the present confusion of coding can be resolved.
• These codes are separate and distinct from evaluation and management codes, and should be billed separately.
• These codes are to be used for inpatient and outpatient osteopathic manipulative treatment services along with the appropriate evaluation and management codes.
• These codes define the body regions appropriately for use with osteopathic manipulative treatments.

Using The Codes

These patient vignettes are designed to give specific examples of the types of services involved in the procedure codes for osteopathic manipulative treatment. Examples featuring different specialist physicians and surgeons are used in the examples to illustrate that any physician may utilize all of the codes found below. The definitions of body areas are found in the ICD-9 reference text under the codes 739.0 through 739.9.

After evaluating a patient and arriving at a diagnosis which includes somatic dysfunction it is appropriate to utilize an evaluation and management (E&M) code to describe the evaluation and management service. If the diagnosis includes somatic dysfunction, the physician then utilizes one of the following procedure codes for describing the service of rendering OMT to treat the dysfunction. Note that these procedure codes do not include the service involved in determining a diagnosis.

98925 OMT to one to two body regions defined.
A 39-year-old presents to the family practitioner with right ankle pain following an injury. After the evaluation and assessment of the patient the physician arrives at a diagnosis of (1) ankle sprain and (2) somatic dysfunction of the right lower extremity. This is coded for by utilizing an appropriate E&M code. The use of 98925 involves the treatment by the family practitioner utilizing application of osteopathic manipulative treatment to the right lower extremity.

98926 OMT to three to four body regions defined.
A 4-year-old female presents to her pediatrician with a fever, cough, and sputum production. After the E&M assessment and coding, a diagnosis of (1) bronchitis and (2) somatic dysfunction of the cervical, thoracic, rib and abdominal area is determined. The bronchitis is treated with medications. The subsequent use of 98926 involves the treatment by the pediatrician of the somatic dysfunction of the cervical, thoracic, rib and abdominal regions utilizing osteopathic manipulative treatment.

98927 OMT to five to six body regions defined.
A 42-year-old male presents to the neurosurgeon with confusion and pain in the neck and upper back and exacerbation of a previous history of lumbar disc herniation with radiculitis following a motorcycle accident. After E&M assessment and coding, the diagnosis is that of (1) closed head injury and (2) somatic dysfunction of the head, cervical, thoracic, lumbar, sacral and rib region. The subsequent use of 98927 involves the treatment by the neurosurgeon of the somatic dysfunction of the head, cervical, lumbar, sacral and rib regions utilizing osteopathic manipulative treatment.

98928 OMT to seven to eight body regions defined.
Following cholecystectomy, a 32-year-old female develops abdominal pain and distention. After E&M assessment and coding, the attending physician and surgeon arrives at a diagnosis of (1 ) post-operative ileus and (2) somatic dysfunction of the head, cervical, thoracic, lumbar, sacral, ribs and abdominal/visceral regions. The subsequent use of 98928 involves the treatment by the surgeon of the somatic dysfunction of the head, cervical, thoracic, sacral, rib, and abdominal/visceral regions utilizing osteopathic manipulative treatment.

98929 OMT to nine to ten body regions defined.
A 29-year-old female complains of generalized aching, low back pain and cephalgia following a vaginal delivery. After assessment of the patient using an E&M code the family practitioner arrives at a diagnosis of (1 ) cephalgia and (2) post-obstetric somatic dysfunction of the head, cervical, thoracic, rib cage, lumbar, sacral, pelvic, and upper and lower extremity regions. The use of 98929 then involves the application by the family practitioner of osteopathic manipulative treatment to the head, cervical, thoracic, rib cage, lumbar, sacral, pelvic abdominal upper and lower extremity areas.

Complete and easily understandable documentation for OMT is necessary to ensure adequate third party comprehension of the procedures for appropriate payment. Different forms of osteopathic documentation exist and should be reviewed for appropriate application. Available sources for information on terminology and codes include the Glossary of Osteopathic Terminology as published by the AOA, and information in CPT, HCPCS and ICD-9-CM.

A commonly used method of documentation for OMT is illustrated in the use of the SOAP note. SOAP is an acronym for a format of recording information found during a physician visit. It includes Subjective complaints and histories from the patient; Objective findings of the physician's exam and tests; Assessment or differential diagnosis based on the first two; and Plan that is the course of treatment designed by the physician.

Somatic dysfunction is a diagnosis utilized by osteopathic physicians to code for disorders in the skeletal, arthrodial, myofascial and visceral structures as well as related vascular, Iymphatic, and neural elements. Palpatory findings may include, but are not limited to, tenderness, asymmetry, range of motion abnormalities and tissue texture changes. A more detailed list of terms and definitions can be found in the AOA Glossary of Osteopathic Terminology.

In general, osteopathic manipulative techniques include, but are not limited to, three broad categories: soft tissue techniques such as stretch, gentle range of motion, and kneading; direct techniques such as joint mobilization, thrust and muscle energy; and, indirect techniques such as myofascial release, strain/counters/rain and cranial osteopathy. A complete list of techniques and their descriptions can be found in the AOA Glossary of Osteopathic Terminology.

New Patient

S. A 20-year-old African-American male complains of low back pain that began 3 days ago after he lifted a heavy object. Cannot straighten up when walking. Pain with change of position. Denies radiation of pain, it stays along the low back and waist line. Denies areas of numbness. Comfortable when Iying down. Aspirin helps some. Has used heat with some help. No prior history of back pain or injury. Denies allergies. Medical/surgical history is unremarkable.

O. Tenderness noted over lumbar and sacral regions Inability to extend lumbar spine when standing Flexion posture when standing Muscle spasms noted in paraspinals of the lumbar region Decreased range of motion of lumbar spine and sacrum was noted on active and passive motion testing neurologic exam normal

A. 1. Lumbosacral sprain/strain 846.0
2. Somatic dysfunction lumbar, sacral 739.3 and 739.4

P. 1. OMT (appropriate techniques used)*, applied to the lumbar and sacral regions
2. Continue aspirin
3. No lifting, bending or twisting
4. Follow up in two days to reevaluate patient progress

Coding For This Case

Evaluation/management; new patient 99203
OMT two body regions; lumbar/sacral 98925

Established Patient

S. Patient is here for a recheck. He states that the pain has decreased in his low back and that he can get around better. He states that he has no radiation of pain into his legs. He does state that he feels stiff and achy if he tries to do his normal daily activities. He is still taking aspirin with some relief.

O. Tenderness with palpation and stretch of the erector spinaemuscles
Pain with extension and rotation left of L5
Pain along right Sl joint with sacral extension
No muscle spasms noted with active or passive range of motion
Negative neurologic exam of lower extremities

A. 1. Lumbosacral sprain/strain; improving 846.0
2. Somatic Dysfunction, lumbar, sacral; improving 739.3, 739.4

P. 1. OMT (appropriate techniques used)* to lumbar and sacral regions
2. Instructed on proper posture when lifting
3. Increase home activities gradually and to tolerance 4. Follow up if improvement does not continue

Coding For This Case

Evaluation and management; established patient 99213
OMT two body regions; lumbar, sacral 98925