Wiki E/M Services more than 2x per month denied?

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insight

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Hello,
I a biller for a couple of osteopaths that specialize in OMT (osteopathic manipulation) and we usually bill a office visit with a 25 modifier and OMT procedure code. Recently with our motor vehicle patients, we tend to see them more often because they are in an acute state, insurance companies are denying the office visit code if the patient was seen more than once in a month? We are having to appeal these over and over again.

Any ideas or suggestions? This is causing such a headache!

Thanks
 
E/M above and beyond OM performed?

From a payor point of view, I can understand why insurance companies might deny these claims. If you feel as though the documentation supports an additional e/m above/beyond the OM, then you will need to send chart notes to support this.

From my experience, we have denied a lot of these types of instances as the documentation just wasn't there to support an additional e/m.

Just curious, what is warranting an additional E/M above & beyond the OM?
 
We include chart notes with our MVA claims so the adjuster can review the documentation each time we bill. The osteopaths I work for evaluate and manage each time someone comes in. After the evaluation they decide whether the manipulation would be helpful and if so we bill for the office visit and the omt. I believe that since Osteopaths are sometimes "lumped in or confused" with Chiropractors. Insurance companies sometimes see our visits as the same as a chiropractic appointment.

Thanks for the response!
 
I notice you said these are MVA claims, what state are you in? Depending on your state's No Fault/PIP laws, you may only be allowed a certain # of OV's per month along with treatment. Here in NJ for example, per the NJ PIP Fee Schedule only 2 E/M's provided along with therapeutic services are allowed per 30 day period. I would double check your law/statute to see if there is a regulation in place that governs this.
 
Documentation is the key. If note states patient is to return for OMT, then OMT is all you can bill (unless new problem or issue is discussed). If note states "follow up for reevaluation and possible treatment", then E/M and OMT can be billed.

CHECK OUT THIS LINK. The article is loaded with information. Our DOs used these guidelines and we are getting paid for both E/M and OMT....however we do not bill for MVAs. We only bill private/commercial insurance.
http://www.acofp.org/Practice_Management/OMT_Coding_Stategies_to_Boost_Your_Bottom_Line/
 
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