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OMT Indications, Contraindications & Documentation
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OMT Indications, Contraindications & Documentation

When to use, when to avoid, how to write the note.

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◆When OMT is indicated

  • •Somatic dysfunction (TART present)
  • •As adjunct in musculoskeletal pain (low back, neck, shoulder)
  • •Tension/cervicogenic headache
  • •Pregnancy-related low back/pubic pain
  • •Post-operative ileus, atelectasis (with appropriate caution)
  • •Otitis media (in conjunction with abx)
  • •Asthma, COPD exacerbation (lymphatic + rib raising)
  • •Pneumonia (rib raising + lymphatic pump adjunct)
  • •Sinusitis (lymphatic + cranial)
  • •Functional GI complaints (IBS, constipation, gastroparesis)
  • •Pediatric: colic, plagiocephaly, torticollis, otitis

◆Absolute contraindications to OMT (entire toolkit)

  • •Lack of patient consent
  • •Severe systemic illness (sepsis, hemodynamic instability)
  • •Recent fracture (at the dysfunctional site)
  • •Acute spinal cord injury
  • •Acute MI (defer OMT)

◆Relative contraindications

  • •Specific technique-based — see other notes
  • •Anticoagulation (favor gentle indirect)
  • •Severe osteoporosis (avoid HVLA)
  • •Acute infection or abscess at site
  • •Recent surgery at site (within 6 weeks)

◆Documentation (SOAP note OMT section)

  • •Subjective: chief complaint, pain quality, location, severity
  • •Objective: TART findings — name dysfunctions by direction of FREEDOM (e.g., 'C4 FRSL, T5 ERSR, R on R sacrum, anterior innominate L')
  • •Assessment: include diagnosis + somatic dysfunctions found
  • •Plan: list techniques used (e.g., 'ME to C4, counterstrain to PC4 tender point, HVLA to T5'), patient response, follow-up plan

◆Billing & ICD-10 (OMT-specific)

  • •M99.0x: segmental and somatic dysfunction by region (M99.00 head, M99.01 cervical, M99.02 thoracic, M99.03 lumbar, M99.04 sacral, M99.05 pelvic, M99.06 LE, M99.07 UE, M99.08 rib, M99.09 abdomen)
  • •CPT 98925-98929 based on body regions treated (1-2, 3-4, 5-6, 7-8, 9-10)
  • •Document specific dysfunctions per region

High-yield pearls

  • ◆Always assess and document TART before treatment
  • ◆Name dysfunctions by direction of FREEDOM, not restriction
  • ◆Tailor technique to the patient (acute → indirect; chronic with good tolerance → direct)
  • ◆Always reassess after treatment and document patient response
  • ◆OMT is an adjunct, not a substitute for definitive medical treatment
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