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Medicare doesnt recognize mod 33?

  1. Default Medicare doesnt recognize mod 33?
    Medical Coding Books
    Hi there everyone! I just had a McVey Seminar and an ACOG refresher course for "Medicare Screening Services for 2011. They were very indepth about coding screening services that are NOT subject to cost sharing (ie ded/copay) at the time of covered (problem) E/M service.
    The example given was geared specifically toward Medicare:
    99213-25 w/problem diag
    G0101-GA, 33 w/a screening dx: v76.2, V76.47, V76.49, or V15.89
    Q0091-GA, 33 w/a screening dx: V76.2, V76.47, V76.49, or V15.89
    The GA indicates an ABN has been signed, the 25 mod indicates the E/M service was significant & seperately identifiable (not part of pap or pelvic) and the 33 indicates G0101 and Q0091 are not subject to cost sharing.
    I had this exact scenario & sent it to MCR. It was DENIED for incorrect modifier! I called CMS they said that Mod 33 is NOT a valid modifier for Medicare! I read it to her right from ACOG & McVey handouts-she said send the claim back w/out 33-they DONT recognize 33! HELP! What's real?! Thanks!

  2. #2
    Location
    Columbia, MO
    Posts
    12,840
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    You do not use the 33 modifier for services that are inherently preventive such as the G0101 and the Q0091 and if this is the every other year for the patient you would not use the GA if it is not the covered year then I believe it would be the GX modifier not the GA for noncovered service.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Lauderdale Lakes
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    203
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    Here is a link explaining the 33 modifier.

    http://www.ama-assn.org/resources/do...e-services.pdf

  4. #4
    Location
    North Carolina
    Posts
    3,126
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    Quote Originally Posted by ljhr@juno.com View Post
    Hi there everyone! I just had a McVey Seminar and an ACOG refresher course for "Medicare Screening Services for 2011. They were very indepth about coding screening services that are NOT subject to cost sharing (ie ded/copay) at the time of covered (problem) E/M service.
    The example given was geared specifically toward Medicare:
    99213-25 w/problem diag
    G0101-GA, 33 w/a screening dx: v76.2, V76.47, V76.49, or V15.89
    Q0091-GA, 33 w/a screening dx: V76.2, V76.47, V76.49, or V15.89
    The GA indicates an ABN has been signed, the 25 mod indicates the E/M service was significant & seperately identifiable (not part of pap or pelvic) and the 33 indicates G0101 and Q0091 are not subject to cost sharing.
    I had this exact scenario & sent it to MCR. It was DENIED for incorrect modifier! I called CMS they said that Mod 33 is NOT a valid modifier for Medicare! I read it to her right from ACOG & McVey handouts-she said send the claim back w/out 33-they DONT recognize 33! HELP! What's real?! Thanks!
    Q/A from Palmetto GBA...

    Question:
    Does Medicare want to see CPT modifier 33 on claims when a patient comes in for a DEXA (dual-energy X-ray absorptiometry) scan, CBCs (complete blood counts) and other services that are a part of a wellness check?

    Answer:
    No, Medicare does not accept CPT modifier 33.

    http://www.palmettogba.com/palmetto/...on%7C%7C%7C%7C

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