Primary Care Coding Alert

Question: When a family physician (FP) manipulates the cervical region on both the right and left sides, the right and left extremities and the abdomen. Should I count the treatments as three areas (98926) or five areas (98927)?

Michigan Subscriber

Answer: The answer depends on whether the FP treated both the upper and lower extremities. The osteopathic manipulation treatment (OMT) codes (98925-98929) refer to 11 body regions:

  head
  cervical
  thoracic
  lumbar
  sacral
  pelvic
  lower extremities
  upper extremities
  rib cage
  abdomen
  viscera. Whether the FP performs multiple manipulations in a region doesn't matter. So you shouldn't count left and right manipulations in the same area, such as the cervical region.
 
Bilateral also doesn't apply to the extremities. Therefore, instead of focusing on the extremity's side, you should look at whether the FP treated the upper or lower extremities.
 
In your case, you should count one OMT for each of these regions:
  cervical
  abdomen.  You may also add OMT of the:
  lower extremities
  upper extremities. Bottom line: You should report either OMT of three or four body regions. This amount doesn't affect the code you should use. Code 98296 (Osteopathic manipulation treatment [OMT]; three to four body regions involved) refers to OMT involving three-four body regions.