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May 27
OMT Coding Edits – Appeal Denials in July
by  John CrosbyNo presence information  on 5/27/2011 12:21 PM

In other health care policy news, the AOA has become aware of several payors who have recently begun denying nerve block codes when billed with OMT.  These denials are ostensibly based on coding edits that state the codes are bundled when billed together on the same date of service as OMT.   The basis for the edits stems from the OMT codes being classified as global surgery procedures under the Medicare Physician Fee Schedule Data Base.   CMS recently reconsidered these edits and has since decided to delete, effective 7/1/11, the edits that led to denial of these claims.  If any DOs have had claims denied based on these edits, you may choose to request a reopening, if permitted, or appeal the denied claims to your local Medicare claims processing contractor after 7/1/11 – or contact the AOA Division of Socioeconomic Affairs for more information.​

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OMT Coding Edits – Appeal Denials in July

I am noticing that several insurers are again attempting to deny payment for E&M along with OMT when properly coded with the -25 modifier. They simply drop the modifier and pay only for the OMT. Culprits include Cigna, United Health Care, and Shasta administrative services. Please pass this on to the appropriate administrators of the AOA. Hopefully some legal/$ consequences might be brought to bear upon the perpetrators of these inappropriate practices.
William Brooks, DO on 5/27/2011 4:22 PM
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