Medical Billing Forum

Coding => Coding => Topic started by: mkurisudo on July 18, 2008, 09:36:56 AM

Title: Osteopathic Family Medicine Office Visits
Post by: mkurisudo on July 18, 2008, 09:36:56 AM
Greetings, I am an Osteopath and am Board Certified in Family Medicine. I am also very proficient in Osteopathic Manipulative Treatment. I see patients for a variety of issues and every office visit with each patient is 50 min to one hour in length. Each office visit most likely is associated with an Osteopathic Treatment as well.

I am wondering about the best way to code for my visits.

Currently I am coding E +M 99213-99214 with modifier -25 associated with OMT CPT codes 98925-98929.

Pretty much the majority of my patients have chronic issues (HTN, DM2, Anxiety, obesity, migraines, CAD, etc...) that are addressed and meet 99213 and 99214 as office visits and this is documented in the chart.

Most have pain and somatic dysfunction as well of some region, (neck pain, back pain, knee pain, etc...) and thus OMT is applied to patient.

Someone told me that since my office visits are structured that every patient I see gets an hour of my time (I see max 10 patients a day) I can also use the 99354 code for extended services. I go over each chart with patient in the room and address each issue they come in with.

this would mean my billing sheet would look something like this:

99213-99214 with modifier -25 E+M
98925-98929 CPT for OMT
99354 for Extended Services

Should I just use the 99215 code?


Title: Re: Osteopathic Family Medicine Office Visits
Post by: Michele on July 18, 2008, 04:48:26 PM
   We actually bill for a provider very similar to you.  He is a DO, who is board certified in Emergency Medicine (worked many years as an ER doc) and now has a family practice also treatment many patients with osteopathic manipulation as well as regular ov's for chronic conditions.

   He currently bills the E&M codes 99213 or 99214 with the 25 modifier along with the osteopathic manipulation codes.  Similar to you, most office visits run 45 minutes to an hour.

     It would be appropriate to bill the prolonged visit code in addition to the other codes as long as the criteria for all codes are met.  For example a 99214 requires that 2 of the 3 main criteria are met:

   1.  Key Components (2 of 3 meet or exceed requirements)
         1. E/M Detailed History
         2. E/M Detailed Exam
         3. E/M Moderate Complexity Medical Decision
   2. Problem Severity
         1. E/M Moderate Severity Problem
         2. E/M High Severity Problem
   3. Physician Time: 25 minutes

and the criteria for the 99354:

99354 - Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour

To report a prolonged service, the evaluation and management service provided must exceed the typical time specified in the code by at least 30 minutes.

I do not know if insurance carriers will allow anything for the 99354.  Each plan will vary, but if you are meeting the requirements I would recommend billing it.  After all, you can always adjust it off if the insurance disallows it.

Good luck.

Title: Re: Osteopathic Family Medicine Office Visits
Post by: mkurisudo on July 19, 2008, 08:41:34 AM
Thanks for the info. You have been very helpful!

I have been very careful with full documentation to make sure all E+M are met and documentation of total Face to Face time with time in and time out.

If using code 99354 often will that 'draw attention' (red flag) if billing out to Medicare?
(I have been staying away from using 99215 too often for the same reason - even though my documentation supports it)

Also, is it possible to bill and code for trigger point injection or other procedure (shave bx) on same visit as OMT?
Would modifier -25 cover this or would need to use modifier -51?

Lets say for example:

Chronic patient, with multiple other problems: HTN, DM2, obesity, low back pain, knee pain.
60 min office appointment addressing issues.
OMT for low back pain.
Trigger point injection in muscle around knee.

I am assuming it would look like this:
99214-99215 E+M with -25 modifier
98925-98929 OMT CPT
20552 Trigger point injection 1 muscle group

Again, Thanks so much for your help. I am a solo practitioner and do all my own billing/coding/scheduling/patient rooming etc... and learning lots as I go. Just want to make sure I am doing it all correctly.


Title: Re: Osteopathic Family Medicine Office Visits
Post by: Michele on July 19, 2008, 09:19:29 PM
Yes you can bill for the injection on the same visit.  You just need to make sure the diagnoses point to the right services.  For example, the E&M code needs to indicate that the office visit was for the HTN, Diabetes & obesity (obesity being last) and the osteopathic manipulation for the low back pain, and the injection for the knee pain. 

As long as the E&M has other diagnoses it is usually allowed separately.  If you billed the E&M with low back pain and knee pain, then the osteopathic manip and the injection for the same diagnoses, it may not be allowed.

You do have to be careful with billing too many 99215's but if your notes support you then you should be all right.  Medicare does track how many times (%) of 99215's you bill as opposed to your colleagues. 

The same with the 99354's.  If you bill them for every visit, it may trigger an audit.

Good luck,

If you get to the point where you are too busy, we do have experience in your field.

Title: Re: Osteopathic Family Medicine Office Visits
Post by: jns85008 on August 22, 2008, 04:30:37 AM
I use the 99354 for many different scenerio's. Most insurances do recognize it and actually reimburse quite well.
Title: Re: Osteopathic Family Medicine Office Visits
Post by: Michele on August 22, 2008, 11:01:02 AM
Thanks for the info.  I didn't know anyone who had billed it out, so I wasn't sure it was reimbursable by insurance carriers.  I'm going to show the info to my DO.