Mich. Admin. Code R. 418.10203 - Office visit or other outpatient visit for evaluation and management of patient in conjunction with ongoing osteopathic manipulative treatment or chiropractic manipulative treatment
Rule 203.
(1) The
carrier shall reimburse for the initial evaluation and management examination
billed by the provider before initiating chiropractic or osteopathic
manipulation. The carrier shall also reimburse for osteopathic manipulative
treatment or chiropractic manipulative treatment if the treatment is initiated
on the same date of service.
(2)
All of the following provisions apply to ongoing osteopathic manipulative
treatment:
(a) Osteopathic manipulative
treatment procedure codes include pre-manipulative patient evaluation. The
physician may bill a separate evaluation and management service using modifier
code -25. The carrier shall only reimburse the service if the documentation
provided supports significant change of signs and symptoms or the evaluation of
another work related problem not included in the procedure or service that
required the encounter. The physician shall document the rationale for the
significant other service in the record.
(b) Osteopathic manipulations are to be
billed using procedure codes 98925-98929.
(3) All of the following provisions apply to
ongoing chiropractic manipulative treatment:
(a) The chiropractic manipulative treatment
codes include a pre-manipulation patient evaluation. The provider may report a
separate evaluation and management service using modifier -25 to designate a
separate identifiable service. The carrier shall reimburse the evaluation and
management service only when the provider documents significant change of signs
and symptoms or the evaluation of another work related problem not included in
the procedure or service that required the encounter. The provider shall
document the rationale for the significant other service in the
record.
(b) The carrier shall
reimburse chiropractic manipulative treatment when the provider bills the
service with procedure codes 98940-98942.
(4) If either a doctor of osteopathy or a
doctor of chiropractic, conducts a periodic re-evaluation, then a report of the
evaluation shall accompany the bill. A periodic re-evaluation report shall
include all of the following information:
(a)
A description of the evaluation of function in measurable terms based on
physical findings and problem identification.
(b) A goal statement.
(c) A treatment plan.
(d) Physical and functional improvement in
measurable terms that has occurred in relationship to the diagnosis for which
the treatment was prescribed.
(e)
The likelihood of continued improvement if treatment is continued.
Notes
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