Presenter Sarah James DO D isclosures I have no corporate or pharmaceutical sponsorship Objectives Review general guidelines for documentation billing and coding for outpatient EM visits ID: 711823
Download Presentation The PPT/PDF document "Making Money with OMT Review of Billing ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Making Money with OMT
Review of Billing and Coding Office visits with OMT
Presenter: Sarah James, DOSlide2
Disclosures
I have no corporate or pharmaceutical sponsorshipSlide3
Objectives
Review general
guidelines for documentation, billing
and coding for outpatient E/M visits
Discuss procedural cost for preforming OMT
Review specific scenarios when OMT is utilized and how to confidently
document, bill
and code for it
Practice applying new our refreshed knowledge to actual cases Slide4
E/M Service Coding
Patient
type
Setting
of
service
Level
of E/M service performed. Slide5
Patient type
Patient Type
New
Establish
Setting of Service
Office, other outpatient setting
Hospital inpatient
Emergency
Dept
Nursing facilitySlide6
Level of E/M Service Provided
Three key components
History
Chief Complaint
Location, Duration, Quality, Severity, Timing, Context, Modifying factors, Associated Symptoms
ROS-pertinent, extended, complete
PFSH-Past, Family, and social history
Physical Exam-focused or detailed
Medical Decision Making-straight forward, minimal complexity, moderate complexity, High ComplexitySlide7
Documentation Basics
For any level for an ESTABLISHED patient you need two out of three levels metSlide8
History For Established Patient
Level
3 (99213):
needs 2+ components plus 1 ROS no PSFH
Level
4 (99214):
needs 4+ components, plus 2 ROS, PLUS one PSFHSlide9
Exam for Establish Patient
Level
3 (99213)
needs 2+ components
Level 4
(99214) needs
5+ components or one DETAILED exam +2 other systemsSlide10
Medical Decision Making for Establish Patient
Level
3 (99213)
needs minimal
Level
4 (99214)
needs moderateSlide11
The Key is:
Documentation
Documentation
DocumentationSlide12
OMT Procedure Documentation
Step 1) Document physical exam findings and osteopathic findings(somatic dysfunctions) in your note
You must have documentation of the somatic dysfunctions found in each body region that you are treating.
There are 10 possible body regions.
Regions are: Head, cervical spine, thoracic spine, lumbar spine, sacrum, pelvis, upper extremity, lower extremity, ribs, and abdomen/other
ex) Body Region, Somatic dysfunction C spine: Hypertonic PSM and trapezius
bilat
:, Pelvis: left innominate
restriction:,Lower
extremity: Hypertonic quads and psoas
bilatSlide13
OMT Procedure Documentation
Step 2) Use allopathic diagnosis a your “primary” diagnosis
code(s)
ex
) cervicalgia, tension headache, lumbago,
sinusitis, and/or
hip
pain
Step
3)
Then add the regions that you treated (this is correlated directly with the somatic dysfunction documentation in your
note)
M99.00
Segmental and somatic dysfunction of
head
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 upper
extremity
M99.07
Segmental and somatic dysfunction of lower
extremity
M99.08
Segmental and somatic dysfunction of rib
cage
M99.09
Segmental and somatic dysfunction of abdomen and other regionsSlide14Slide15
OMT Billing and Coding
Step 4) Bill for the appropriate level of
service
Most
often will be 99213 (level 3) or 99214 (level 4)
Step 5) Add the appropriate billing code for the number of regions you treated
98925 1-2 regions $32.42
98926 3-4 regions $42.95
98927 5-6 regions $55.82
98928 7-8 regions $65.09
98929 9-10 regions $75.12Slide16Slide17
Can I bill for OV with scheduled OMT?
Yep!
Must evaluate the need for OMT and what SD
is now
present=should ALWAYS be able to get a Level 3 established patient
OV
BUT, often you should use a Level 4 established OV if the problem is acute on chronic or new problemSlide18
What does OMT pay?
98925 1-2 regions $32.42
98926 3-4 regions $42.95
98927 5-6 regions $55.82
98928 7-8 regions $65.09
98929 9-10 regions $75.12Slide19
How much money are we talkin’?
98925 1-2 body regions= $32.27
Average full time pt/day=18
Treat 3 pts with 98925(plus OV)/day= ~$100
4 days in clinic/week= $400, $1600/month
46 week year=$18,400
Treat 4 pts/day x 5 days/wk x46 wks=$29,440Slide20
ICD-10!
ICD-10-CM/PCS is a replacement for ICD-9-CM diagnosis and procedure codes.
The
implementation of ICD-10-CM/PCS will not impact the use of CPT and alpha-numeric Healthcare Common Procedure Coding System codes. Slide21
Case 1-Lets practice
What level of service is this history?Slide22
Case 1
Level 4
Has at least 4 HPI elements, 2-5 ROS, and 1 PFSHSlide23
Case 1
What Level of service is this exam?Slide24
Case 1
Level 4
Has at least 5 systemsSlide25
Case 1
What Level is this decision making?Slide26
Case 1
Moderate—Level 4
Advised on medication use/discontinue, labs for other possible causes of patient’s symptoms that are not clearly definedSlide27
Summary of Case 1
History-Level 4
Exam-Level 4
Medical Decision making-Moderate=Level 4
Establish patient: Only need 2 of 3 to achieve level of service Level 4 (99214)Slide28
Case 2-HistorySlide29
Case 2-History
Level 4
Has at least 4 HPI elements, 2-5 ROS, and 1 PFSHSlide30
Case 2-ExamSlide31
Case 2-Exam
Level 4
Has
at least one detailed exam and 2 othersSlide32
Case 2- with OMTSlide33
Case 2-Decision Making
Level 3 or 4
Minimal to moderate due to adjustment of LyricaSlide34
OMT Procedure
Treated 10 of 10 possible body regionsSlide35
Summary of Case 2
History- Level 4
Exam- Level 4
Medical Decision Making- Level 3-4
2 of 3 met=Level 4 (99214)
PLUS OMT procedure, add -25 modifier
With Slide36
Case 3
S: Nursing notes reviewed. Aleah Harris is a 5 year old female who presents with a 1 day(s) history of left - ear pain. Dull ache. No drainage out of the ear. Associated upper respiratory symptoms: cough, rhinorrhea and fever up to 102.5 for 3 days. Ibuprofen and tylenol alternating daily. Has not had any medicine today. Is behaving normally today. Over the weekend was more lethargic and took a naps which is unusual. Past history of ear problems: episodic past otitis media and last time was in January 2014.Slide37
Case 3-History
Level Slide38
Case 3-Exam
BP 100/52[ped's cuff, rt arm[, Pulse 128, Temp 101.8 °F (38.8 °C), Temp Src: Oral, Resp 30, Ht 3' 8.5" (1.13 m), Wt 48 lb (21.773 kg),
Ears: Right: External - normal Canal - nonerythematous TM - nonerythematous, cone of light intact
Left: External - normal Canal - nonerythematous TM - intact erythema, dullness, behind TM purulent fluid
Nose/Sinuses: clear rhinorrhea, edematous turbinates
Oropharynx: no erythema or exudate
Neck: anterior cervical nodes - bilateral
Lungs: clear to auscultationSlide39
Case 3-Exam
Level Slide40
Case 3-Medical Decision Making
A/P AOM- Ceftin for 10 days. OMT, mother verbally consented
Discussed home care and OTC medications for symptomatic relief.
Recheck as needed for persistent, worsening, or new symptomsSlide41
Case 3-Exam
Level Slide42
OMT Documentation
Cranial: Left internally rotated temporal bone
Cervical: OA-ERrSl, hypertonic PSM
Sacrum: Bilat sacral flexion
Treatment: Cranial, ME, MFR, and Soft Tissue
Patient tolerated procedure, symptoms improved, and somatic dysfunction improved.Slide43
Case 3
What DX do you document?
1-AOM
(primary)
2-Nonallopathic somatic dysfunction of Head
3-Nonallopathic somatic dysfunction of Cervical
4-Nonallopathic somatic dysfunction of SacrumSlide44
How do I add OMT to Office Visit?
Bill for your level 3, 4, or 5 OV, PLUS regions treated with -25 modifier.Slide45
Case 3-Summary
History
Exam
Medical Decision Making
OMT Slide46
Case 4-HistorySlide47
Case 4-ExamSlide48
Case 4- Medical Decision MakingSlide49
Questions?
Hope this was helpful Slide50
References
Waller, T
MD;Level
II vs Level III Visits: Cracking the
Codes.Fam
Pract
Manag
.
2007 Jan;14(1):21-25
.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf
http://www.thenationalcouncil.org/wp-content/uploads/2013/01/ICD-10MythsandFacts.pdf