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Old 05-24-2013, 09:12 AM
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Default Routine exam

The way the coding guidelines are now, we can file a separate E/M at the same time as a preventive exam. With the new I-10 codes, there is a code for encounter for medical exam without abnormal findings Z00.00 and a code for exam with abnormal findings Z00.01. With this addition, will this mean the separate E/M would not be used?
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Old 05-24-2013, 09:55 AM
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Maybe. The documentation would have to clearly reflect that the patient had no complaints or issues, then upon the exam the provider finds a problem that was unexpected.
But rather than a preventive with an ov why not bill a high level supported by the document with the 33 modifier.
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Old 05-24-2013, 10:16 AM
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I thought the 33 modifier was only for procedures like a screening colonoscopy that turned diagnostic.
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Old 05-28-2013, 08:29 AM
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There is no restriction to the use of the 33 modifier, it is only that most examples only explain the 33 modifier with the colonoscopy example. Also I would like to point out that in no way am I promoting fraud which a fellow member has seen fit to point that finger at me.. I am saying that for ICD-10 CM the code states general exam with abnormal finding.. this means the patient cannot present with a complaint and the documentation must be clear about this. It is not unusual for the provider to find an abnormality during a routine yearly exam.. such as a breast lump.
The use of the 33 modifier on a high level office visit was first suggested by the AMA in a newsletter in Dec of 2010. I do not see how in anyway this suggests fraud!
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Old 05-28-2013, 01:34 PM
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Do the insurance carriers apply preventative care policies such as "no deductible, and no copay" to a regular E/M code (for example 99214) when billed with mod 33?
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Old 05-28-2013, 01:37 PM
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That is the way it is suppose to work.
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Old 05-28-2013, 01:42 PM
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hmmm I hadn't thought of using the mod with E/M I think that could really work, solves the whole is this a prevenative or E/M or both question....
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Old 05-28-2013, 01:48 PM
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I think It will also but do be prepared to appeal it, the payers have been just as confused about the 33 modifier as everyone else.
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Old 05-28-2013, 02:00 PM
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Thank you for the info
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Old 05-28-2013, 02:03 PM
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Interesting topic! I queried my company top ten carriers regarding modifier 33 and they came back with " modifier 33 is not recognized and does not alter payment" but I never though or considered using it on an e/m.

Has anyone had any success utilizing it?
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