Modifier -33

[nsteinhauser]

Does anyone have any documentation that directs coders to use modifier -33 only once per dos?
Would appreciate any references, etc.
Thank you in advance.

 

[daniel]

This may help.

 

[nsteinhauser]

Thank you for your reply.

What I was getting at was when you have a screening colonosocpy turned diagnostic for a commercial payer, patient 50 yo, for example.
The doctor removes a polyp with a cold biopsy forceps and removes another polyp with a snare. I would code this:
45385 -33
45380 -59 -33
or
45385 -33
45380 -33 - 59 (It doesn't seem to make any difference to the payers for the order of the 33 and 59 modifiers).
Edits come back from our claims edit software stating "33 modifier is not appropriate for 45380" in this example. They give this edit for any 2nd or 3rd colonoscopy I add a -33 to.
Was wondering if there is documentation out there that states you can only use -33 on the first line, or something like that.
Thanks again!

 

[daniel]

Interesting. Alot of commercial follow Medicare, so you code just flip the 33 to PT, see if that clears the edit. I don't think you'll find a official source stating to apply modifier 33 in first position. Based on coding sequencing logic, 33 would be last position in this context. Since it's a information modifier, so leaving it as 59.33 is fine.
Just my take.

 

[amla12]

Have you tried using the XS-33 instead of 59-33 on the 45380?

 

[daniel]

I'm a 59er, but my higher up likes to use these X modifiers. To me, same difference. But XS could work.

 

[nsteinhauser]

I use -XS -PT with MCR and MCR plans (if there is a second line....only -PT on first line) because our MCR contractor will deny with a -59-PT and say a more specific modiifer is needed.
But these are commercial and again, it's not the payers, per se, it's the editing software that doesn't like any -33's after the first line.
I will try a -XS - 33. I've tried using the -PT with commercials and they get edited, also. But I haven't tried the -XS - 33.
Thank you for your ideas.

 

[mpurisima]

There's a really good webinar "On Demand webinar by AAPC" that goes into details about that. It's dated 08/09/2023. It will help clear up a lot of things for you on modifier -33 versus modifier -PT.