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Thread: Routine exam

  1. #1

    Default Routine exam

    The way the coding guidelines are now, we can file a separate E/M at the same time as a preventive exam. With the new I-10 codes, there is a code for encounter for medical exam without abnormal findings Z00.00 and a code for exam with abnormal findings Z00.01. With this addition, will this mean the separate E/M would not be used?

  2. #2
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    Maybe. The documentation would have to clearly reflect that the patient had no complaints or issues, then upon the exam the provider finds a problem that was unexpected.
    But rather than a preventive with an ov why not bill a high level supported by the document with the 33 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

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    I thought the 33 modifier was only for procedures like a screening colonoscopy that turned diagnostic.

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    There is no restriction to the use of the 33 modifier, it is only that most examples only explain the 33 modifier with the colonoscopy example. Also I would like to point out that in no way am I promoting fraud which a fellow member has seen fit to point that finger at me.. I am saying that for ICD-10 CM the code states general exam with abnormal finding.. this means the patient cannot present with a complaint and the documentation must be clear about this. It is not unusual for the provider to find an abnormality during a routine yearly exam.. such as a breast lump.
    The use of the 33 modifier on a high level office visit was first suggested by the AMA in a newsletter in Dec of 2010. I do not see how in anyway this suggests fraud!

    Debra A. Mitchell, MSPH, CPC-H

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    Do the insurance carriers apply preventative care policies such as "no deductible, and no copay" to a regular E/M code (for example 99214) when billed with mod 33?
    Melissa Jewett, CPC

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    That is the way it is suppose to work.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    hmmm I hadn't thought of using the mod with E/M I think that could really work, solves the whole is this a prevenative or E/M or both question....
    Melissa Jewett, CPC

  8. #8
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    I think It will also but do be prepared to appeal it, the payers have been just as confused about the 33 modifier as everyone else.

    Debra A. Mitchell, MSPH, CPC-H

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    Thank you for the info
    Melissa Jewett, CPC

  10. #10
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    Interesting topic! I queried my company top ten carriers regarding modifier 33 and they came back with " modifier 33 is not recognized and does not alter payment" but I never though or considered using it on an e/m.

    Has anyone had any success utilizing it?
    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"

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