OD / MD / CHIROPRACTOR / CST CHECKLIST
Comparison of Manipulative Approaches
Unlike D.C.’s and P.T.’s, D.O.’s do not typically set a “treatment plan” i.e., initial evaluation followed by a recommendation of a defined series of treatments followed by reevaluation at the completion of the “treatment plan.” Rather, a D.O.’s decision to utilize manipulative treatment is made on a visit-by-visit basis depending on the condition of the patient at the time of each reevaluation. This may lead to a significantly lower number of manipulative services rendered per patient on average than that typically provided by D.C.’s and P.T.’s.
While there are some similarities between chiropractic manipulation (CMT) and OMT, there are some distinct differences as well. The chart below outlines some of the distinctions in education, licensure, practice patterns, etc. among doctors of osteopathic medicine, doctors of chiropractic, and physical therapists, all of whom have some forms of manual therapy procedures within their respective scopes of practice.
Clearly, chiropractors and osteopathic physicians have differences in their training and education. They also approach the musculoskeletal system differently. Osteopathic medicine includes a focus on the need to optimize blood circulation to maintain or restore health. In contrast, the chiropractic approach focuses on the nervous system and adjustments of the spinal vertebrae to improve neurotransmission.
The Center for Medicare services (CMS) has determined that there is a significant distinctiveness in what osteopathic physicians do with regards to chiropractors and physical therapists. They have therefore created specific billing codes (CPT: common procedural technology) codes for each profession.
By the creation of distinct codes for OMT, CMT and physical therapy, the CPT Editorial Panel has affirmed that they are satisfied that there are enough distinctions in these approaches to warrant separate codes for reporting of these services. Testimony before the CPT Editorial Panel by the American Osteopathic Association (AOA), the American Chiropractic Association (ACA), and the American Physical Therapy Association (APTA) all recognized the distinctive nature of these services, and the AOA supported the ACA request for establishment of separate CMT codes as well as the APTA’s request for modification in the codes used to report their manual therapy services.
AOA Division of Socioeconomic Affairs
WHAT IS OSTEOPATHIC MEDICINE?
Osteopathic Medicine Defined
|Osteopathic Manipulative Treatment||Chiropractic||Physical Therapy|
|EDUCATION||Following Bachelor's level education, four years of osteopathic medical school plus a minimum of one or two years post-doctoral training (plus board exams) required for licensure.||Following Associate level education, four years of Chiropractic school (plus chiropractic boards) required for licensure.||Master's level education in Physical Therapy following Bachelor's degree required for licensure or registration.|
|LICENSURE||Unlimited license in all states and US Armed Forces for practice of medicine and surgery in addition to OMT.||Limited licensure for treatment of neurosusculoskeletal system; in some states restricted to spine areas only.||Limited license or registration for practice of physical therapy; requires physician referral in some states.|
|PRACTICE PATTERNS||Frequency of treatment determined by ongoing evaluation: "treatment plan" not utilized. Typically fewer encouters per patient. Utilized by multiple physician specialties.||Treatment plan with intermittent reevaluation. Higher frequency of treatment.||Treatment plan set by initial evaluation; reevaluation following completion of plan. Higher frequency of treatment.|
|PRACTICE BASIS||Decision to utilize OMT based on multi-system differential diagnosis; (evaluation and management service); D.O. is responsible for all aspects for patient's diagnosis and treatment.||Based on effect of spinal misalignment on nervous system function.||Diagnosis limited to impairment and functional limitations.|
|CODING DISTINCTIONS||Osteopathic Manipulative Treatment codes:|
98925: Osteopathic manipulative treatment (OMT): one to two body regions involved
98926: Three to four body regions involved
98927: Five to six body regions involved
98928: Seven to eight body regions involved
98929: Nine to ten body regions involved
|Chiropractic Manipulative Treatment codes:|
98940: Chiropractic manipulative treatment (CMT); spinal, one to two regions
98941: Spinal, three to four regions
98942: Spinal, five regions
98943: Extraspinal, one or more regions
|Physical Medicine Manual Therapy code:
97140: Manual therapy techniques (eg. mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes