# Mod 25 with OMT & Acupuncture



## REllifritz (Mar 23, 2009)

I have a question regarding charging OMT & Acupuncture along with an E/M service with a modifier 25 for every visit?  We have a doctor in our practice who wants me to charge an office visit every time she sees a patient for OMT or Acupuncture.  Her documentation is good, including a complaint, ROS, PFSH, and exam. However, I worry that charging an office visit every time puts us at risk for audit, especially when the patient is coming back for the same diagnoses.  Any advice?


----------



## FTessaBartels (Mar 23, 2009)

*Is the patient coming in for the treatment?*

It seems unlikely that a truly "significant separately identifiable" E/M is being performed each and every time the patient comes in for a scheduled treatment - no matter how detailed the history, exam and MDM is. 

I would not routinely use the -25 modifier to capture an additional E/M.

F Tessa Bartels, CPC, CEMC


----------



## RebeccaWoodward* (Mar 23, 2009)

I agree...seems like "fluff".  I compare this to synvisc injections.  Once our orthopods determine the need for synvisc injections, the E/M, *usually* isn't justified.  Have you spoken to physician about your concerns?  Often times, it's just a matter of presenting the facts... w/ CMS guidelines as a resource.


----------



## REllifritz (Mar 24, 2009)

Thanks, F Tessa, for your input.  I haven't been adding an E/M with every treatment our doc does, but I'm trying to convince her that we are putting ourselves at risk.  I needed other coders to back me up on this.  Appreciate it!


----------



## REllifritz (Mar 24, 2009)

Hi Rebecca,
Thanks for the input.  I have spoken with the doc regarding my concerns.  She knows other practices that are doing this, but I think it puts us at risk and I've expressed my views.  I'm presently not adding an E/M with every treatment, only when she has to evaluate a new problem.  I just needed support from other coders on this.  Thanks again.


----------

