295 lines
14 KiB
XML
295 lines
14 KiB
XML
import Article from "@/components/Article";
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import { Metadata } from "next";
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export const metadata: Metadata = {
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title: "Article - OMT Codes | Dr. Feely",
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authors: [{ name: "Richard A. Feely, D.O., FAAO, FCA, FAAMA" }],
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description: `The CPT Editorial Panel ruled to include OMT codes starting in
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the 1994 edition of the CPT Manual. All Physicians Current Procedural
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Terminology [CPT] five-digit numeric codes, descriptions, numeric modifiers,
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instructions, guidelines, and other material are copyright American Medical
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Association.`,
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};
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const ArticleOmtCodes = () => {
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return (
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<Article
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title="OMT Codes"
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author="Richard A. Feely, D.O., FAAO, FCA, FAAMA"
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>
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<h2>Coding</h2>
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<p>
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The CPT Editorial Panel ruled to include OMT codes starting in the 1994
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edition of the CPT Manual. (All{" "}
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<em>Physicians Current Procedural Terminology [CPT] </em>five-digit
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numeric codes, descriptions, numeric modifiers, instructions,
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guidelines, and other material are copyright American Medical
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Association.)
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</p>
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<p>
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Osteopathic manipulative treatment is a form of manual treatment applied
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by a physician to eliminate or alleviate somatic dysfunction and related
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disorders. This treatment may be accomplished by a variety of
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techniques.
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</p>
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<p>
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Body regions are defined as head, cervical, thoracic, lumbar, sacrum,
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lower extremity, upper extremity, pelvis, ribs, abdomen and viscera.
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(Such regions are defined in ICD-9-CM codes 739.0-739.9. This
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information should be shown on the claim form or in the physician
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record.
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</p>
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<div>
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<table>
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<tbody>
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<tr>
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<td>CPT Codes</td>
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<td>Procedure Description</td>
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</tr>
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<tr>
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<td>
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<p>98925</p>
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<p>98926</p>
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<p>98927</p>
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<p>98928</p>
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<p>98929</p>
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</td>
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<td>
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<p>OMT; one to two body regions involved</p>
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<p>OMT; three to four body regions involved</p>
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<p>OMT; five to six body regions involved</p>
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<p>OMT; seven to eight body regions involved</p>
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<p>OMT; nine to ten body regions involved</p>
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</td>
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</tr>
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</tbody>
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</table>
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</div>
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<p>
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The physician, insurance companies, Medicare, Medicaid, workers
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compensation and all other third party reimbursement systems need to
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know the following:
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</p>
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<ul>
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<li>
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These codes are to be used by physicians for osteopathic manipulative
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treatments as of January 1, 1994. It is important that all carriers,
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claims examiners and physicians be educated on the use of these codes
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so that the present confusion of coding can be resolved.
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</li>
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<li>
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These codes are separate and distinct from evaluation and management
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codes, and should be billed separately.
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</li>
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<li>
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These codes are to be used for inpatient and outpatient osteopathic
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manipulative treatment services along with the appropriate evaluation
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and management codes.
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</li>
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<li>
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These codes define the body regions appropriately for use with
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osteopathic manipulative treatments.
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</li>
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</ul>
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<h2>Using The Codes</h2>
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<p>
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These patient vignettes are designed to give specific examples of the
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types of services involved in the procedure codes for osteopathic
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manipulative treatment. Examples featuring different specialist
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physicians and surgeons are used in the examples to illustrate that any
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physician may utilize all of the codes found below. The definitions of
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body areas are found in the ICD-9 reference text under the codes 739.0
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through 739.9.
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</p>
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<p>
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After evaluating a patient and arriving at a diagnosis which includes
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somatic dysfunction it is appropriate to utilize an evaluation and
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management (E&M) code to describe the evaluation and management
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service. If the diagnosis includes somatic dysfunction, the physician
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then utilizes one of the following procedure codes for describing the
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service of rendering OMT to treat the dysfunction.{" "}
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<em>
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Note that these procedure codes do not include the service involved in
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determining a diagnosis.
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</em>
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</p>
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<p>
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<strong>98925</strong> OMT to one to two body regions defined.
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<br />A 39-year-old presents to the family practitioner with right ankle
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pain following an injury. After the evaluation and assessment of the
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patient the physician arrives at a diagnosis of (1) ankle sprain and (2)
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somatic dysfunction of the right lower extremity. This is coded for by
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utilizing an appropriate E&M code. The use of 98925 involves the
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treatment by the family practitioner utilizing application of
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osteopathic manipulative treatment to the right lower extremity.
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</p>
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<p>
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<strong>98926 </strong>OMT to three to four body regions defined.
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<br />A 4-year-old female presents to her pediatrician with a fever,
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cough, and sputum production. After the E&M assessment and coding, a
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diagnosis of (1) bronchitis and (2) somatic dysfunction of the cervical,
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thoracic, rib and abdominal area is determined. The bronchitis is
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treated with medications. The subsequent use of 98926 involves the
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treatment by the pediatrician of the somatic dysfunction of the
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cervical, thoracic, rib and abdominal regions utilizing osteopathic
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manipulative treatment.
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</p>
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<p>
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<strong>98927 </strong>OMT to five to six body regions defined.
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<br />A 42-year-old male presents to the neurosurgeon with confusion and
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pain in the neck and upper back and exacerbation of a previous history
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of lumbar disc herniation with radiculitis following a motorcycle
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accident. After E&M assessment and coding, the diagnosis is that of
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(1) closed head injury and (2) somatic dysfunction of the head,
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cervical, thoracic, lumbar, sacral and rib region. The subsequent use of
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98927 involves the treatment by the neurosurgeon of the somatic
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dysfunction of the head, cervical, lumbar, sacral and rib regions
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utilizing osteopathic manipulative treatment.
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</p>
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<p>
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<strong>98928 </strong>OMT to seven to eight body regions defined.
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<br />
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Following cholecystectomy, a 32-year-old female develops abdominal pain
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and distention. After E&M assessment and coding, the attending
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physician and surgeon arrives at a diagnosis of (1 ) post-operative
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ileus and (2) somatic dysfunction of the head, cervical, thoracic,
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lumbar, sacral, ribs and abdominal/visceral regions. The subsequent use
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of 98928 involves the treatment by the surgeon of the somatic
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dysfunction of the head, cervical, thoracic, sacral, rib, and
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abdominal/visceral regions utilizing osteopathic manipulative treatment.
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</p>
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<p>
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<strong>98929 </strong>OMT to nine to ten body regions defined.
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<br />A 29-year-old female complains of generalized aching, low back
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pain and cephalgia following a vaginal delivery. After assessment of the
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patient using an E&M code the family practitioner arrives at a
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diagnosis of (1 ) cephalgia and (2) post-obstetric somatic dysfunction
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of the head, cervical, thoracic, rib cage, lumbar, sacral, pelvic, and
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upper and lower extremity regions. The use of 98929 then involves the
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application by the family practitioner of osteopathic manipulative
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treatment to the head, cervical, thoracic, rib cage, lumbar, sacral,
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pelvic abdominal upper and lower extremity areas.
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</p>
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<p>
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Complete and easily understandable documentation for OMT is necessary to
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ensure adequate third party comprehension of the procedures for
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appropriate payment. Different forms of osteopathic documentation exist
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and should be reviewed for appropriate application. Available sources
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for information on terminology and codes include the Glossary of
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Osteopathic Terminology as published by the AOA, and information in CPT,
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HCPCS and ICD-9-CM.
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</p>
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<p>
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A commonly used method of documentation for OMT is illustrated in the
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use of the SOAP note. <strong>SOAP </strong>is an acronym for a format
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of recording information found during a physician visit. It includes
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Subjective complaints and histories from the patient; Objective findings
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of the physician’s exam and tests; Assessment or differential diagnosis
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based on the first two; and Plan that is the course of treatment
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designed by the physician.
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</p>
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<p>
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Somatic dysfunction is a diagnosis utilized by osteopathic physicians to
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code for disorders in the skeletal, arthrodial, myofascial and visceral
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structures as well as related vascular, Iymphatic, and neural elements.
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Palpatory findings may include, but are not limited to, tenderness,
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asymmetry, range of motion abnormalities and tissue texture changes. A
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more detailed list of terms and definitions can be found in the AOA
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Glossary of Osteopathic Terminology.
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</p>
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<p>
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In general, osteopathic manipulative techniques include, but are not
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limited to, three broad categories: soft tissue techniques such as
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stretch, gentle range of motion, and kneading; direct techniques such as
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joint mobilization, thrust and muscle energy; and, indirect techniques
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such as myofascial release, strain/counters/rain and cranial osteopathy.
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A complete list of techniques and their descriptions can be found in the
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AOA Glossary of Osteopathic Terminology.
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</p>
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<h2>New Patient</h2>
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<p>
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<strong>S</strong>
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<strong>.</strong> A 20-year-old African-American male complains of low
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back pain that began 3 days ago after he lifted a heavy object. Cannot
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straighten up when walking. Pain with change of position. Denies
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radiation of pain, it stays along the low back and waist line. Denies
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areas of numbness. Comfortable when Iying down. Aspirin helps some. Has
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used heat with some help. No prior history of back pain or injury.
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Denies allergies. Medical/surgical history is unremarkable.
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</p>
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<p>
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<strong>O.</strong> Tenderness noted over lumbar and sacral regions
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Inability to extend lumbar spine when standing Flexion posture when
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standing Muscle spasms noted in paraspinals of the lumbar region
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Decreased range of motion of lumbar spine and sacrum was noted on active
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and passive motion testing neurologic exam normal
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</p>
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<p>
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<strong>A.</strong> 1. Lumbosacral sprain/strain<strong> 846.0</strong>
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<br />
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2. Somatic dysfunction lumbar, sacral <strong>739.3 and 739.4</strong>
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</p>
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<p>
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<strong>P.</strong> 1. OMT <em>(appropriate techniques used)*, </em>
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applied to the lumbar and sacral regions
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<br />
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2. Continue aspirin
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<br />
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3. No lifting, bending or twisting
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<br />
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4. Follow up in two days to reevaluate patient progress
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</p>
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<p>Coding For This Case</p>
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<p>
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Evaluation/management; new patient <strong>99203</strong>
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<br />
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OMT two body regions; lumbar/sacral <strong>98925</strong>
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</p>
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<h2>Established Patient</h2>
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<p>
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<strong>S.</strong> Patient is here for a recheck. He states that the
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pain has decreased in his low back and that he can get around better. He
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states that he has no radiation of pain into his legs. He does state
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that he feels stiff and achy if he tries to do his normal daily
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activities. He is still taking aspirin with some relief.
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</p>
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<p>
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<strong>O.</strong> Tenderness with palpation and stretch of the erector
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spinaemuscles
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<br />
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Pain with extension and rotation left of L5
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<br />
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Pain along right Sl joint with sacral extension
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<br />
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No muscle spasms noted with active or passive range of motion
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<br />
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Negative neurologic exam of lower extremities
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</p>
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<p>
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<strong>A.</strong> 1. Lumbosacral sprain/strain; improving
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<strong> 846.0</strong>
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<br />
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2. Somatic Dysfunction, lumbar, sacral; improving{" "}
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<strong>739.3, 739.4</strong>
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</p>
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<p>
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<strong>P.</strong> 1. OMT <em>(appropriate techniques used)* </em>to
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lumbar and sacral regions
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<br />
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2. Instructed on proper posture when lifting
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<br />
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3. Increase home activities gradually and to tolerance 4. Follow up if
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improvement does not continue
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</p>
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<p>Coding For This Case</p>
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<p>
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Evaluation and management; established patient <strong>99213</strong>
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<br />
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OMT two body regions; lumbar, sacral <strong>98925</strong>
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</p>
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</Article>
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);
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};
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export default ArticleOmtCodes;
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