# osteopathic manipulation



## larkatin (Jan 11, 2010)

D.O. performed services.
Claim submitted to Highmark Medicare as follows:  

98925
62311-59

Allowed 98925, disallowed 62311-59 as follows:  
B15 THIS SERVICE/PROCEDURE REQUIRES THAT A QUALIFYING SERVICE/PROCEDURE BE RECEIVED AND COVERED.  THE QUALIFYING OTHER SERVICE/PROCEDURE HAS NOT BEEN RECEIVED/ADJUDICATED.  NOTE: REFER TO THE 835 HEALTHCARE POLICY IDENTIFICATION SEGMENT (LOOP 2110 SERVICE PAYMENT INFORMATION REF), IF PRESENT. AND,
M80 NOT COVERED WHEN PERFORMED DURING THE SAME SESSION/DATE AS A PREVIOUSLY PROCESSED SERVICE FOR THE PATIENT.

I searched Highmark Medicare and was unsuccessful at finding clarification for the 835 Healthcare Policy.  Are they saying that the ESI is inclusive of the manipulation?  

HELP!


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## marvelh (Jan 14, 2010)

The lumbar ESI code, 62311, is bundled by CCI edits as a column 2 code into the osteopathic manipulation code, 98925.  This edit carries a "0" modifier indicator which means it can not be bypassed for any reason. 

The two services need to be performed on different dates of service.


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