Osteopathic Medicine Resources: Billing & Coding

Modifier -25 allows for separate reporting for E/M and OMT services provided on the same date for initial and subsequent encounters.

Report the appropriate CPT E/M service (99201-99215) code and the appropriate OMT code (98925-98929). Append Modifier -25 to the E/M service code.

Documenting E/M Service: Document the patient’s chief complaint, history, examination and medical decision making.

Documenting OMT: Document the region(s) identified during the exam diagnosed with but not limited to somatic dysfunction or disorders in the skeletal, arthrodial, myofascial and visceral structures as well as related vascular, lymphatic and neural elements. It may be beneficial (but not required) to prepare a separate procedure note detailing which regions were manipulated, the utilization of techniques and how the patient tolerated the treatment.

Documentation tips:

• Always separate your E/M services from the procedure note. Your documentation should identify that a separate and significant E/M was performed the same day as the OMT.
• Always precede OMT with E/M that clinical supports the medical necessity for the services.
• Never bill more than one E/M service per physician per day.
• Never use modifier -59 instead of modifier -25.