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New Modifier 33, uses?

  1. Default New Modifier 33, uses?
    Medical Coding Books
    Is anyone using this new modifier for colorectal screenings? Is it basically the same thing as PT, but for non-medicare patients? I never really heard much about it, just kind of stumbled across it compared to the mass news of PT.

  2. #2
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    Madison Area Chapter in Madison WI
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    113
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    Quote Originally Posted by blathrop19@gmail.com View Post
    Is anyone using this new modifier for colorectal screenings? Is it basically the same thing as PT, but for non-medicare patients? I never really heard much about it, just kind of stumbled across it compared to the mass news of PT.
    There is a fair amount of confusion on the intended use of Modifiers 33 and PT. Although Modifiers 33 and PT seem to be connected, they identify different things.

    I'll talk about Modifier 33 first. The short answer to when you are to use Modifier 33 is on "preventive services". The long answer is in Michellde's post from 1-3-11. I've included an excerpt at the bottom of this page.

    Insurance carriers have known about this for awhile because they had to identify preventive services that were included in the mandate. I have worked with a group of carriers to identify how they were going to do that. My experience is that carriers have identified these services by CPT, HCPCS, and/or ICD codes or a combination of these. So they don't "need" the Modifier 33 to identify preventive services that have no cost sharing.
    From a coding perspective, we should use Modifier 33 when applicable.

    OK - now Modifier PT. First, although Modifiers 33 and PT seem to be connected, they identify different things. Stick with me here.

    Modifier 33 identifies screening/preventive services. Modifier PT is used to identify when a "screening/preventive" services turns into a diagnostic/theraputic service.

    The most common example for Modifier PT would be when a person has a screening colonoscopy and a polyp is found. If the polyp is removed, the "screening" turns into a therapeutic procedure. In this situation, Modifier PT is used to identify that the procedure started as a screening but ended up a therapeutic procedure. Medicare will waive the deductible in this situation. This is not part of the USPSTF mandate.


    CPT modifier 33 is applicable for the identification of preventive services without cost-sharing in these four categories:

    1.Services rated “A” or “B” by the US Preventive Services Task Force (USPSTF) (see Table 1) as posted annually on the Agency for Healthcare Research and Quality's Web site: http://www.uspreventiveservicestaskf...spsabrecs.htm;

    2.Immunizations for routine use in children, adolescents, and adults as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;

    3.Preventive care and screenings for children as recommended by Bright Futures (American Academy of Pediatrics) and Newborn Testing (American College of Medical Genetics) as supported by the Health Resources and Services Administration; and

    4.Preventive care and screenings provided for women (not included in the Task Force recommendations) in the comprehensive guidelines supported by the Health Resources and Services Administration.

    US Preventive Services Task Force. USPSTF A and B Recommendations. August 2010. Available at: http://www.uspreventiveservicestaskf...uspsabrecs.htm.
    __________________
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

  3. Default use of 33 with personal history of polyps dx V12.72
    Hi,
    Does anyone have information that if a patient is having a colonoscopy due to a personal history of previous colon polyps, V12.72, would you use 33 with that if nothing is found?

    Marci

  4. #4
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    Madison Area Chapter in Madison WI
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    Quote Originally Posted by Mklaubauf View Post
    Hi,
    Does anyone have information that if a patient is having a colonoscopy due to a personal history of previous colon polyps, V12.72, would you use 33 with that if nothing is found?

    Marci
    Does the patient have signs or symptoms? If not, it would be screening colonoscopy. If no polyps are found, Modifier 33 would be used. If polyps are found and removed, it is no longer a screening and Modifier 33 would not be used.

    Also keep in mind, if the intent is a screening and polyps are found and removed, the new Modifier PT should be used to identify that the procedure started as a screening, but turned in to a theraputic procedure.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

  5. #5
    Location
    Columbia, MO
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    If polyps are found it was still performed for screening purposes so it is still screening, with the V code for screening listed first and the polyps listed second. The use of the 33 or PT in this case will be payer specific. Thre PT was created for this purpose and then the 33 was created with the example give of a screening colonoscopy that turns diagnostic. However it became confusing when they tried to describes its other uses. If a screening coloscopy is performed with no other problem found and no other procedure necessary there is no need for the 33 or the PT as the procedure is inherently preventive. The 33 is used when a procedure or service is not inherently preventive but has elements which are being done for preventive reasons. If you are using the Gcode for screening colonoscopy then you need no modifer. If you have a payer that does not accept the G code for a screening with no findings then I could see using the 33 modifier on the CPT code for colonoscopy.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default V12.72
    Hi Debra,
    Where is it documented that if a patient with history of colon polyps, no other signs or symptoms , that if the intent is a screening colonoscopy, that you can list as the primary diagnosis as screening V76.51 with a seconday Dx of V12.72 if nothing is found?

    The reason I keep questioning this is in the ICD-9 manual, page 21 & 22, it states "personal history codes may be used in conjunction with follow-up codes and family history codes may be used with screening codes to explain the need for a test or procedure."

    It doesn't state that you can put personal history codes with screening. My physician keep asking where is it documented that they can state screening colonoscopy for personal history of colon polyps? I don't know what to tell them. We keep hearing we have to follow ICD-9 guidelines, yet I dont' want patients to miss out on screening benefits either.

    Thank you for any help.,
    Marci

  7. Default v1272
    Quote Originally Posted by Claudia Yoakum-Watson View Post
    Does the patient have signs or symptoms? If not, it would be screening colonoscopy. If no polyps are found, Modifier 33 would be used. If polyps are found and removed, it is no longer a screening and Modifier 33 would not be used.

    Also keep in mind, if the intent is a screening and polyps are found and removed, the new Modifier PT should be used to identify that the procedure started as a screening, but turned in to a theraputic procedure.
    what if we use V1272 as the primary dx code? do we add pt if polyps are found?

    thanks
    bhobbs

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