Wiki Screenings/Modifiers

[meghanb413]

Just looking for clarification on modifier 33 as I'm hearing and reading contradicting things.

If a patient [with commercial insurance] comes in for a screening/surveillance should modifier 33 be appended or no?

https://www.aapc.com/blog/84107-code-colonoscopies-with-precision/#Coding Colonoscopies

above states append modifier 33 to indicate preventative services [which is what I thought], but I'm now being told otherwise.

 

[coderbeth]

33 is used when a screening becomes a diagnostic exam, meaning if a patient comes in for a screening, but the colonoscopy ends up being a biopsy or polypectomy, you add the 33 modifier to the claim to indicate the patient's colonoscopy was planned as screening but became something else.

 

[meghanb413]

33 is used when a screening becomes a diagnostic exam, meaning if a patient comes in for a screening, but the colonoscopy ends up being a biopsy or polypectomy, you add the 33 modifier to the claim to indicate the patient's colonoscopy was planned as screening but became something else.

See but this contradicts the AAPC article I attached saying 33 should be appended to 45378 for commercial insurances.

 

[jkyles]

Hi there, report modifier 33 for a screening exam. Medicare and some private payers want modifier PT when a screening exam converts to a diagnostic service.

 

[Dmmegs123]

See but this contradicts the AAPC article I attached saying 33 should be appended to 45378 for commercial insurances.

Can you supply the URL for this AAPC article? I've only been appending (like other) a modifier when the screening turns therapeutic. I believe you are stating that if the 45378 is used for a commercial screening, Mod 33 should be added. Thank you.

 

[meghanb413]

Can you supply the URL for this AAPC article? I've only been appending (like other) a modifier when the screening turns therapeutic. I believe you are stating that if the 45378 is used for a commercial screening, Mod 33 should be added. Thank you.

https://www.aapc.com/blog/84107-code-colonoscopies-with-precision/#Coding%20Colonoscopies

Above is the AAPC article but I've come across other sources that seem to say the same thing as well.