Wiki Use of PT and 33 modifiers with high risk screenings

[andreagail]

Help! I have a patient who was in for a high risk screening due to personal history of colonic polyps. Another polyps was found in the latest colonoscopy. Should I bill this to Cigna with the 45385 with modifier 33 added? Not sure about the use of these modifiers with high risk screenings. Any thoughts anyone?

 

[Lindseywingate1990]

i would use the modifier 33/PT depending wether it is a medicare or commercial carrier but, that does not specify to the insurance wether the patient is at high risk or not i would use the personal history code V12.72 to show the patient is at high risk. hope this helps!

 

[coachlang3]

If it was a snare it would look like this for Cigna:

45385 (CPT)

33 (modifier)

V76.51, 211.3, V12.72 (ICD-9 dx)

Yes I understand the 33 mod along with the V76.51 seem redundant. But that is how you would code your scenario.