Wiki DO billing Chiro Manipulations

[mwagone1]

Can a doctor of osteopathy bill for chiropractic manipulations (98940-98942)? I know that CPT/AMA does not define the word "provider" and refers you back to your state guidelines (I'm in PA) and that the outcome of chiropractic manipulations is different than the outcome of osteopathic manipulation. So if the desired outcome by the DO does fit within the chiropractic manipulation outcome vs. osteopathic, is he then within his rights to bill it? Technically, he is over-qualified to bill the code if looking at provider-type.
Per Michael Miscoe on an AAPC Webinar:
- Chiropractic Principles focus on restoring joint position to influence neurologic function on the premise that normal neurologic function will allow the body to effectively heal itself.
- The Osteopathic outlook simply looks to influence organ system function through correction of joint dysfunction (less stated emphasis on the neurologic component even though correction of the somatic problem relies on neurologic function).

 

[drlcupon]

My understanding is that the code that most accurately reflects the services rendered is the code to be chosen. If the DO has training in CMT and his services reflect that vs OMT, then he is within his right to bill a CMT code. Hopefully his notes reflect this information.

Leanne Cupon, DC, CCPC
Cumming, GA

 

[mmiscoe]

The difference between CMT and OMT, per CPT, has nothing to do with licensure or technique. Instead, based on the respective descriptions in CPT, the difference is the outcome of the service (resolution of somatic dysfunction-OMT, or alleviating neurophysiologic joint dysfunction - CMT. While some might argue it is a distinction without a difference, it is the difference identified in CPT.