Modifier 33

[rsboggs]

I thought that the modifier PT was to be attached to a preventative colonoscopy that then turned diagnostic. This is the first I have heard of the 33 modifier?

[kbartrom]

Are all Medicare carriers expecting use of this modifier? Seems as if there would be more education...

[mitchellde]

PT is for Medicare and 33 is for all other payers

[laurasullivan]

I have read the AMA documentation on the new modifier, but I can't find anything on CMS or Palmetto.gba (our MAC) on the use of this modifier.

Does anyone have a link to the Medicare policy on this?

thanks

[Mklaubauf]

Does anyone have any documentation if V12.72 is considered preventive under the colorectal screening under the U.S. Task Force. I'm not sure if we do a colonoscopy for V12.72 and find nothing, if we should use modifier 33?

Any thoughts
M. Klaubauf, CPC

[Jacky]

What about modifier "PT" I thought this was a new modifier that was added to colonoscopies when they turned from screening do diagnostic? How is this different from "33"

[Jacky]

Does anyone know about modifier PT? that was suppose to be new and serve the same purpose.

[kbartrom]

It was noted above that the PT modifier is for Medicare and 33 for all other payers. Is there documentation to support this? I did find the following on the ASC Review website:

A new HCPCS modifier takes effect Jan. 1, 2011, for use in cases where a screening colonoscopy or screening flexible sigmoidoscopy was planned, but clinical findings leads to a diagnostic colonoscopy, according to the Ambulatory Surgery Foundation.

Modifier –PT will "prompt the claims processing system to waive the deductible for ALL surgical services on the same date of service as the diagnostic service," according to the ASF. "Unlike the additional waiver of copayments and coinsurance for straight screening services allowed by the Patient Protection and Accountable Care Act, if the planned screening service becomes a diagnostic service, only the deductible is waived."

The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

[mitchellde]

from the december CPT assistant:
In response to this PPACA requirement, CPT modifier 33 has been created to allow providers to identify to insurance payers and providers that the service was preventive under applicable laws, and that patient cost-sharing does not apply. This modifier assists in the identification of
preventive services in payer-processing-systems to indicate where it is appropriate to waive the deductible associated with copay or coinsurance and may be used when a service was initiated as a preventive service, which then resulted in a conversion to a therapeutic service. The most notable
example of this is screening colonoscopy (code 45378), which results in a polypectomy (code 45383).
Note that Medicare has created HCPCS II codes for some of these preventive medicine services. CPT modifier 33 is effective after January 1, 2011, and should be appended to codes representing the preventive services, unless the service is inherently preventive, eg, a screening mammography
or immunization recognized by the Advisory Committee on Immunization Practices (ACIP). If multiple
preventive medicine services are provided on the same day, the modifier is appended to the codes for each preventive service rendered on that day.

[kbartrom]

Ok, slowly but slowly putting this together. I was surprised that modifier 33 would be required but there has been little education (other than here on the forum!). The following explains:
PPACA specifies that group health plans or insurance coverage existing on the date of enactment (March 23, 2010) are not required to comply with certain plan requirements under PPACA. These include, for example, the requirement for coverage of preventive care at no cost to the participant or insured. As explained in the preamble to the IFR, however, PPACA does not address at what point changes to such group health plan or health insurance coverage are significant enough to cause the plan or health insurance coverage to cease to be a grandfathered plan, leaving that question to regulatory guidance.

The interim final regulations (IFR) set out the specific requirements that a group health plan or insurance carrier must comply with in order to maintain status as a “grandfathered” plans. In general, the rules provide that grandfather plans will lose their status if “they choose to make significant changes that reduce benefits or increase costs to consumers”,