ljhaley@gmail.com
Networker
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!
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!