Results 1 to 4 of 4

33 and UNITED HEALTHCARE

  1. #1
    Default 33 and UNITED HEALTHCARE
    Medical Coding Books
    Preventive vs. Diagnostic Services:
    Certain services can be done for preventive or diagnostic reasons. When a service is performed for
    the purpose of preventive screening and is appropriately reported, it will be adjudicated under the
    Preventive Care Services benefit.
    Preventive services are those performed on a person who:
    1. has not had the preventive screening done before and does not have symptoms or other
    abnormal studies suggesting abnormalities; or
    2. has had screening done within the recommended interval with the findings considered normal;
    or
    Preventive Care Services
    Page 4 of 30
    Coverage Determination Guideline
    Confidential and Proprietary, © UnitedHealthcare, Inc. 2011
    3. has had diagnostic services results that were normal after which the physician
    recommendation would be for future preventive screening studies using the preventive
    services intervals.
    4. has a preventive service done that results in a therapeutic service done at the same encounter
    and as an integral part of the preventive service (e.g. polyp removal during a preventive
    colonoscopy), the therapeutic service would still be considered a preventive service.
    Examples include, but are not limited to:
     A woman had an abnormal finding on a preventive screening mammography and the
    follow up study was found to be normal, and the patient was returned to normal
    mammography screening protocol, then future mammography would be considered
    preventive.
     If a polyp is encountered during preventive screening colonoscopy, the colonoscopy,
    removal of the polyp, and associated facility, lab and anesthesia fees done at the same
    encounter are covered under the Preventive Care Services benefit.
    When a service is done for diagnostic purposes it will be adjudicated under the applicable nonpreventive
    medical benefit.
    Diagnostic services are done on a person who:
    1. had abnormalities found on previous preventive or diagnostic studies that require further
    diagnostic studies; or
    2. had abnormalities found on previous preventive or diagnostic studies that would recommend a
    repeat of the same studies within shortened time intervals from the recommended preventive
    screening time intervals; or
    3. had a symptom(s) that required further diagnosis.
    Examples include, but are not limited to:
     A patient had a polyp found and removed at a prior preventive screening colonoscopy. All
    future colonoscopies are considered diagnostic because the time intervals between future
    colonoscopies would be shortened.
     A patient had an elevated cholesterol on prior preventive screening. Once the diagnosis
    has been made, further testing is considered diagnostic rather than preventive. This is true
    whether or not the patient is receiving treatment.
     If a Preventive service results in a therapeutic service at a later point in time, the
    Preventive Service would be adjudicated under the Preventive Care Services benefit and
    the therapeutic service would be adjudicated under the applicable non-preventive medical
    benefit.
    Related Services:
    Services that are directly related to the performance of a preventive service are adjudicated under the
    Preventive Care Services benefit. . For example, all services for a preventive colonoscopy (e.g.
    associated facility, anesthesia, pathologist, and physician fees) are adjudicated under the Preventive
    Care Services benefit. Note, however, that benefit adjudication is contingent upon accurate claims
    submission by the provider, including diagnosis, procedure, age and gender.



    This is from the UNITED HEALTHCARE website
    LG CPC,CASCC

  2. #2
    Default
    United Healthcare does not use modifier 33 in making preventive care benefits determination. You must follow the coding instruction in the CDG on Preventive Care Services.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. #3
    Default
    Yes that was the point to my posting this from UNITEDHEALTHCARE
    LG CPC,CASCC

  4. #4
    Default
    Quote Originally Posted by ASC CODER View Post
    Yes that was the point to my posting this from UNITEDHEALTHCARE
    Thanks

    I've been finding that the majority of carriers are recognizing modifier 33 but it has no impact on how they process the claims. Probably not until Medicare starts utilizing it will others start to follow.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

Similar Threads

  1. 29880 and United HealthCare
    By IRISHCODER in forum Orthopaedics
    Replies: 1
    Last Post: 06-28-2013, 07:37 AM
  2. United Healthcare
    By JENNKBICKLEY92 in forum Dermatology
    Replies: 2
    Last Post: 06-18-2013, 10:07 AM
  3. wellness for united healthcare
    By jessBoyer in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 12-14-2011, 02:17 PM
  4. United healthcare
    By ALPINE in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 11-30-2011, 05:21 PM
  5. United healthcare ins ???
    By MsMaddy in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 05-19-2010, 05:17 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.