The AAO Board of Trustees created the Osteopathic Medical Economics Committee to form as an informational resource for members dealing with difficulties regarding coding reimbursement for OMT. The committee also reviews documents and audiovisual materials pertaining to medical economics issues, which can be used to influence coverage and reimbursement policies of third-party carriers and legislators alike. The committee serves as a resource for members, insurance companies and attorneys who need access to OMM experts for medical opinions, depositions and court testimony.
The American Osteopathic Association has many valuable resources available via the Internet to facilitate appropriate physician reimbursement for uniquely osteopathic services provided to their patients. For example, you can download as .pdf files the following documents:
- Documentation Guidelines for Evaluation and Management Services which explains when it is appropriate for the DO to bill for delivery of osteopathic manipulative treatment in conjunction with an evaluation and management service (office visit.)
- Protocols for Osteopathic Manipulative Treatment which explains the rationale for utilization of OMT in patient care.
- Osteopathic Coding 2002 provides updated information on appropriate policies for coding and reimbursement
- Resources for New Physicians in Practice
To access these and other resources, log onto www.osteopathic.org, go to Professional Development and click on Practice Management.
www.ama-assn.org (click on “professional resources”)
Accurate coding is a skill learned to maximize reimbursement. Requirements of Current Procedural Terminology (CPT) and the Centers for Medicare and Medicaid Services (CMS) are accepted throughout the United States, but Medicare contractors and insurers may have varying interpretations of some of the requirements.
New patient: a patient who has not received care from you or members of your group in any service location in the past 3 years. Therefore, if an established patient has not received care from you or your group in the past 3 years, patient can be billed as a new patient.
Group Practice: physicians belonging to the same Medicare billing group identification in the same specialty.
What are the Criteria for E&M Visits?
- Chief complaint (CC)
- History of Present Illness (HPI)
- Review of Systems
- Past History, Family History, Social History
Other important information to help with grading your medical decision-making should include: Source of Information, e.g., patient, chart or other; miscellaneous information important to physicians, e.g., allergies, prior infectious diseases.
Exam: number of organ systems
Medical Decision Making (MDM)
- List of diagnosis and management provided
- Studies reviewed and new studies ordered if needed
- Complexity (straightforward, moderate, high)
- Risk level to patient
Time spent Counseling, etc.
To establish how many systems are needed to determine a level of billing, please refer to www.cms.hhs.gov, www.acofp.org.
Acceptable Tips on Documentation:
- All other review of systems are negative.
- Family history unchanged since last visit or give a date.
List of CPT Codes:
- New office codes: 9920L-99205
- Established office codes: 992L1-99215
- Initial hospital consultation codes: 99251-99254
- Follow-up hospital consultation codes: 9923L-99233
- Outpatient office consultation codes: 9934L-99245