# Modifier 33



## nc_coder (Jan 21, 2014)

I understand using this modifier with a colonoscopy.  However, I work for a Family Practice.  Could I use this modifier when a patient comes in for a Physical and there is also a diagnostic or therapeutic service provided?  
Example:  A 55 year old comes in for annual visit.  He also has hypertension.  There is a separate E/M service for the hypertension because the current plan of treatment was discussed and changed.  
Currently we are billing this as 99396 (V70.0), 99213-25 (401.9).  Could I bill the 99213 with a modifier 33?  If so, would the 33 be "instead of" the 25 or "in addition to"?
Many patients now get "free" preventive services and they do not understand when they come in for their physical that they may have another service that would be subject to their copay or deductible.  We do have them sign a form before they have their physical informing them of the possibility, but most do not pay attention to it and then get upset when they get a bill from us.


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## mitchellde (Jan 21, 2014)

you should not be chaging an office visit unless the patient has a complaint in addition to the annual.   Also you cannot use the 33 in the way you have proposed.  If you have a patient that presents for primarily preventive service then there can be no co pay to the patient, meaning you cannot charge a visit level.  With ICD-10 CM the General visit codes Z00.- do not allow you to bill a preventive with another dx code.  If however you have a patient presenting for the annual with no complaints and yet the provider discoveres something abnormal then you can bill a high level visit with the 33 modifier, insead of the prevent code with an office visit.


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## Sephardic (Jan 21, 2014)

I don't think a modifier 33 would apply to this situation. I don't think you can put it on a problem oriented office visit code like 99213. I thought the modifier was for preventative services only. Patients still need to pay for problem oriented services.
I read that modifier 33 does not have to be appended to those services that are inherently preventive (for instance, screening mammography). It says in the CPT book under the description "for services specifically identified as preventative, the modifier should not be used." So putting it on the 99396 probably isn't necessary.


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## mitchellde (Jan 21, 2014)

the 33 is for a service that is not inherently preventive when that service is performed for preventive reasons.  It does work on a 99213.  you cannot use it on the preventive codes.  you can no longer have a well patient with a problem visit after Oct 1, 2014, you can have a well patient with an abnormal finding, but you cannot charge an ov in addition to the preventive visit when the primary reason for the encounter is preventive. The only answer is to bill the ov level with a 33 modifier.


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## nc_coder (Jan 22, 2014)

Those were my thoughts on the use of this modifier also.  I just wanted someone else's opinion on it.  I was aware of the new ICD10 codes for annual physical and cannot wait for those to come into effect.  For the 4 years I have been with this practice, I have been fighting the Preventive visit with additional E/M.  Our senior physician insists on using this for almost every patient that comes in for a physical.  I, personally, think it is overused here.  He swears his documentation backs up the use of the separate service.  I have strong questions about it in some cases.  But, he and the office manager have started monitoring the claims for physicals that go out and are making me question the other providers in the office when a separate E/M is not charged.


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