Texas Society of the American College of Osteopathic Family Physicians

Coding and Billing

A Word from Our Executive Director

Dear Staff;

I know the challenges of working as part of the administration team for your osteopathic family physician.  I spent eight years working for a solo osteopathic family practitioner in a tiny rural community just outside of Austin, Texas doing everything from appointment scheduling, medical billing and referrals and occasionally filling in for the back office staff.

Though I am no longer in this environment, I continue to do medical billing privately which helps keep me up to date on the challenges you face every day.

It is my desire to help you with the day to day operations of running a family practice based on what I have learned.

Your osteopathic family physician is a uniquely skilled individual with specialized training above and beyond other physicians training.   He or she is skilled in the area of Osteopathic Manipulative Medicine (OMM or OMT) and the unique philosophies and skill sets that go with the title “D.O.” or Doctor of Osteopathy.

I hope that you will find your experience a rewarding one and that the information you find on our website will contribute to that positive experience.

Sincerely yours;

Kris Beavers

Executive Director

Most Common Codes for O.M.M. or O.M.T.

98925 Osteopathic manipulative treatment; one to two body regions involved

98926 Osteopathic manipulative treatment; three to four body regions involved

98927 Osteopathic manipulative treatment; five to six body regions involved

98928 Osteopathic manipulative treatment seven to eight body regions involved

98929 Osteopathic manipulative treatment nine to ten body regions involved

There are specific ICD-9 codes that must be used in order to be paid for these services. They are the set of codes for somatic dysfunction which are 739.0 through 739.8

Most Common Codes for Office-Outpatient Visits

These are for evaluation and management and coordination of patient care; they should not be used for physical examinations.  If you are unfamiliar with these codes you should read the Evaluation and Management section of your CPT Code book for a complete description of each code.

New Patient____________________________Established Patient

99201                                                                                      99211

99202                                                                                      99212

99203                                                                                      99213

99204                                                                                      99214

99205                                                                                      99215

Well Exam-Preventive Codes

These codes are broken down by age bracket.  They can be used for physical exams and “well woman” (gynecological) exams for infants, children and adults.

New Patient_______________________________Established Patient

99381                   ages zero to 1                                           99391

99382                   ages 1 to 4                                                99392

99383                   ages 5 to 11                                              99393

99384                   ages 12 to 17                                            99394

99385                   ages 18 to 39                                            99395

99386                   ages 40 to 64                                            99396

99387                   ages 65 +                                                  99397

The ICD9 codes for these visits will be;

V20.2 for routine infant or well child check ups

V70.0 for routine general medical check up (generally teenagers fall into this category)

V72.31 for routine gynecological or “well woman” exams

While there are other codes for physical exams they are for “other” reasons and generally are not considered payable by insurance companies because they are considered as third party responsibility such as in the case of a physical for summer camp.

Some of the Most Common ICD-9 Diagnosis Codes for Family Practice Physicians

The vast majority of ICD-9 diagnosis codes will require a 4th or 5th digit.  This provides the greatest level of specificity.  I have listed the code and where an additional digit is required this is denoted by one or two blanks following the code for the 4th and or 5th digit.  If you do not use the most specific code your claim will not be accepted by the insurance company you are sending it to.

Consider using a computer program such as “Code Manager” which contains the entire contents of the ICD-9 and CPT Code Books as well as other coding resources, so you can more easily look up these codes.

465._ Acute Upper Respiratory Infection               250._ _ Diabetes

466._ Acute Bronchitis                                            401._ Hypertension

461._ Acute Sinusitis                                               272._ Disorders of Lipid Metabolism

477._ Allergic Reaction                                           244._ Acquired Hypothyroidism

692._ Dermatits                                                       381._ _ Non Supperative Otitis Media

382._ _ Supperative Otitis Media                           789._ Abdominal Pain

008._ _ Intestinal Disorders                                    719._ _ Disorders of Joint (pain)

These of course are by no means exhaustive but could conceivably get you through the majority of your day.  Don’t forget to look up and read these codes for yourself in order to make sure you are using the most specific code for your patient.

© 2006 Copyright TXACOFP

Page Updated 11/3/2006