Billing + Coding

Question 1

CPT code for 1-2 regions:

Answer 1

98925

Question 2

CPT code for 3-4 regions

Answer 2

98926

Question 3

CPT code for 5-6 regions

Answer 3

98927

Question 4

CPT code for 7-8 regions

Answer 4

98928

Question 5

CPT code for 9-10 regions

Answer 5

98929

Question 6

You do OSE and find left lunate anterior, right radial head posterior, left hemidiaphragm restriction, left thoracic inlet F RrSl, OA F RrSl, Left innominate upshear. What level CPT code?

Answer 6

You find issues in 5 regions (lunate and radial head in one) so you would do a CPT code for 5-6 regions which is 98927

Question 7

You do OSE and find OA F RrSl, C3 F RSR, Left thoracic inlet F RSL, T3-4 N RrSl, Left subscapularis TP, Left Rib 4 inhaled, left hemidiaphgram. What level CPT code?

Answer 7

You find issues in 6 regions (thoracic inlet and thoracic spine goes together)

98927

Question 8

What is the most common modifier for OMT billing attached to a visit?

Answer 8

25 modifier

Question 9

What is a 25 modifier?

Answer 9

Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

Question 10

What is another common modifier that may include OMT besides the most common modifier?

Answer 10

59 modifier

Question 11

What is the 59 modifier?

Answer 11

is for a distinct procedural service to indicate that two or more procedures were performed during the same visit to different sites on the body

can use if were performing omt and another procedure (such as trigger point injections) at same visit

Question 12

What are the different OMT billing regions? (recognize these for the CPT billing questions)

Answer 12

Head (cranial and OA)

Cervical (include scalenes)

Thoracic (includes thoracic inlet)

Ribs (+ sternum and manubrium)

UE (include subscapularis TP and clavicle)

Abdomen (includes everything below abdominal diaphragm down to pelvis)

Lumbar

Pelvis

Sacrum

LE

Question 13

Multiple areas in same region (aka bilateral or unilateral- ex. left knee SD and right talus SD) count as..?

Answer 13

Multiple areas in same region (aka bilateral or unilateral) count as only ONE extremity. All equal only 1 region for billing purposes

Question 14

ICD9:

Answer 14

nonallopathic lesions

Question 15

ICD10:

Answer 15

somatic dysfunction

Question 16

What are CPT codes?

Answer 16

used for billing clinical encounters w/ patients and also include procedural codes which are used to bill when procedures are performed

(more work by physician, the higher level of code they may bill within appropriate category)

Question 17

What are the categories for E&M coding?

Answer 17

focused, problem focused, expanded problem focused, detailed, comprehensive (moderate, high)

Question 18

Concern of otitis media where you prescribe them a medication will go under what category?

Answer 18

expanded problem focused

Question 19

HTN + hyperlipedemia will go under what category?

Answer 19

Detailed

Question 20

CPT code levels are based on what three elements?

Answer 20

History, PE, and medical decision making

can also bill under counseling/coordination of care (time based cares); indep of 3 other elements

Question 21

For the assessment section, when writing SD diagnoses, how should you list findings?

Answer 21

by body regions, not individual findings

Question 22

For the assessment section, when writing medical diagnoses, what should you do?

Answer 22

be as SPECIFIC as possible if for omm visit; list symptoms only when cause is somatic dysfunction or unknown

Ex.
Symptom diagnosis= LBP
Specific Diagnosis = Lumbar strain

Question 23

What must be present in order to bill for OMT?

Answer 23

a somatic dysfunction

Documentation must reflect that decision to perform OMT was made on that visit based on the physical findings

Question 24

Recommendations for documentation when writing for chief complaint?

Answer 24

Never ever say “here for OMT” or “here for maintenance”

make sure to: List medical diagnoses in addition to SD