Primary Care Coding Alert

Question: A family physician performs an E/M and osteopathic manipulation on the same day. May I report both services?


South Carolina Subscriber


Answer: Yes. You may code both the office visit (OV) (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient ...) and the osteopathic manipulative treatment (98925-98929, Osteopathic manipulative treatment [OMT] ...).

Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99201-99215 to identify the E/M as a significant, separate service from the manipulation.

Good news: You don't need to have different diagnoses. The American Osteopathic Association supports coding the E/M and OMT without separate ICD-9 codes. CPT also states that "different diagnoses are not required for the reporting of the OMT and E/M service on the same date." The FP evaluates the patient and performs the OMT after that.

Example: An established patient presents to an FP complaining of lateral epicondylitis (726.32). The FP performs a level-three E/M visit and an OMT of the patient's left arm. You would code the E/M with 99213-25 and the OMT with 98925 (... one to two body regions involved).