1. Billing and Coding

Question 1

What are E&M codes?

Answer 1

CPT (common procedure terminology) codes that are used for billing clinical enounters AND procedures with patients. The codes vary based on the location of the encounter.

Question 2

ICD9 vs ICD10

Answer 2

ICD9 and ICD10 are a list of diagnosis.

1. ICD9 => nonallopathic lesions
2. ICD10 => SD

Question 3

More work performed by doc => ____ level of code they can bill for.

Answer 3

higher

Question 4

Levels of codes to use for billing are based on what key 3 elements?

Answer 4

1. HX
2. PE
3. Medical decision making

Question 5

For medicare, _____________ is the #1 determining factor for deciding the level of code

Answer 5

medical decision making

Question 6

What part of the SOAP note includes the elements for billing?

Answer 6

1. S = hx and MDM
2. O = PE
3. A and P = MDM

Question 7

How should “Assessment “be broken down by?

Answer 7

1. Medical Diagnoses (ICD 9 or 10): Be specific; List sx only when cause is SD
   
   1. Symptoms diagnosis: LBP, knee pain, thoracic pain
   2. Specific diagnosis: lumbar strain, arthritis – knee, acquired kyphosis
2. SD Diagnoses (ICD 9 or 10): list body region SD was found, not individual findings

Question 8

• Head (_____, ___, _____)
• Cervical (include scalenes)
• Thoracic
• Ribs
• Upper extremity (includes ___, ___, ____, ___)
• Abdomen
• Lumbar
• Pelvis
• Sacrum
• Lower Extremity (femur and below)

Answer 8

• Head (cranial, OA, hyoid bone)
• Upper extremity (includes scapula, clavicle, subscapularis TP, arms)

Question 9

What body area is OA categorized in

Answer 9

Head or cervical; pick one and be consistent

Question 10

How do you categorize multiple body areas in the SAME region, whether unilateral or bilateral?

Answer 10

Multiple areas in the same region whether unilateral or bilateral still count as only one extremity

Question 11

left talus sd, left knee sd, right fibular head sd => ___ regions

Answer 11

1

Question 12

• What about findings that cross regions (abdominal diaphragm, psoas muscle, thoracic inlet)?

Answer 12

• Choose body area physically assessed then be consistent.

Question 13

OMT billing codes for 9-10 regions?

Answer 13

98929

Question 14

OMT billing codes for 7-8 regions?

5-6?

3-4?

1-2?

Answer 14

o 98925 (1-2 regions)

o 98926 (3-4 regions)

o 98927 (5-6 regions)

o 98928 (7-8 regions)

* code changes every odd number!

Question 15

What modifier do you use when you want to be reimbursed for both the E&M service and OMT procedure that was performed on the same day by the same doctor IF the decision to perform the procedure was made at the time of the encounter?

Answer 15

25 Modifier

Question 16

In order to use 25-modifier, NEVER say _____ when discussing quality of CC.

Answer 16

NEVER say “Here for OMT” or “Here for Maintenance”

Question 17

What modifier do you use to be billed for 2 or more procedures were performed during the same visit to different sites on the body?

Answer 17

59 modifier

Question 18

We may use this code if you were performing OMT and another procedure UNRELATED to the OMT, such as trigger point injections, at the same visit.

Answer 18

59 modifier

Question 19

What justifies use of OMT when billing?

Answer 19

• Dx of SD in assessment. SD dx must be present in order to bill that OMT was performed

Question 20

What should we write for objective if filling for OMT?

Answer 20

• Include SD TART findings as found in different body regions
  
  • TART findings can be: specific findings, or classic specific SD

Question 21

What should we write for assessment if billing for OMT?

Answer 21

• List medical dx + SD by region

(Low back pain, muscle spasm, spinal DJD)

Question 22

What should we say in Plan if we are billing fo OMT

Answer 22

• “Based on todays PE, OMT was perfomed to ___ body region using ____ techniques”
• Always provide care in addition to OMT

Question 23

A ___________ should be present in order to be reimbursed for the E&M service; A ___________ should be present to be reimbursed for a OMT procedure

Answer 23

Medical/symptom diagnosis => E&M service

Somatic dysfunction diagnosis => OMT procedure

Question 24

How to document SD PE findings in objective?

Answer 24

2 ways:

1. Document individual findings: TART (R ASIS tenderness, R ASIS superior, (+) R standing flexion test, L TP of T4 Posteiror)
2. Document specific SD

Question 25

Use the following excerpt from a SOAP note to answer the following:

OSE

• OA F RrSl,
• C4 F RSr,
• Left lunate anterior,
• Right ulna adducted,
• Left rib 10 exhaled,
• Left subscapularis strain and tenderpoint.

What is the correct number of regions treated?

2 regions

4 regions

6 regions

7 regions

8 regions

Answer 25

B. 4 (lunate= hand UE) = 98926

Question 26

Osteopathic Structural Exam:

Left cuboid plantarflexion SD,

Right posterior fibular head,

Left posterior innominate,

L on R sacral torsion,

L5 F RrSr,

T 3-5 N RrSl,

Left hemidiaphragm restriction,

Left subscapularis TP

What is the correct number of regions treated?

Answer 26

7 regions= 98928