Wiki 33 modifiers


Sarasota, FL
Best answers
We are trying to figure out proper usage of the all elusive 33 modifier. When used with a colonoscopy, it is fairly straight forward. If the patient comes in for a screening colonoscopy and something is found we add the 33 modifier to the diagnostic colonoscopy code to indicate it went from screening to diagnostic.

In an article in the Part B News, the scenerio was: patient came in for preventative visit (example 99396) and the doctor determined it was necessary to discuss issues as well. This would then be billed as a preventative visit (99396) and an e/m code with a 33 modifier (let's say 99213-33) it would look like 99396, 99213-33.

Is anyone doing this and having success?
You wouldn't use the modifier 33 on the 99213, you should use a modifier 25 in that scenario.

You would use modifier 33 most often for services which are recommended preventive services by the USPSTF, which is most often going to be related to the mandated preventive services under PPACA.

Many of the services being recommended as preventive under PPACA are due to known medical condition or some sort of history, whether personal or family. An example of this would be that Cholesterol abnormalities screening. The criteria for this preventive service is tied to known risk factors and there are multiple recommendations for this screening based on the patient demographics.

If you haven't already been out to the USPSTF website here is a link with the recommendations specific to PPACA mandated services.

Also the recommendations from the USPSTF is only one of the sources of the PPACA mandated preventive services.

Good luck
Modifier 33 on Children's Well visits

I was wondering if it is appropriate to addModifier 33 to an infant's well visits and if so, does that mean that the office copay does not apply to that visit?
Modifier 33 on Child well visits

What codes are you using for well visits? As I understand this modifier, if you are using a CPT code that is inherently preventive (99381 Init. comp. preventive Medicine E/M...) then you don't use the -33 modifier. Since this is a government initiative and Medicare does not cover these preventive codes at all (99381-99397), I don't think these services are on the list of recommended preventive services. I'd be surprised if any payors waive the copays for these visits.