Wiki Modifier 33

[tas7101999]

We are starting to see an increase in patient responsibility being applied towards the hemoglobin (85018) and finger stick (36416) during the well child exam. Has anyone used modifier 33 with these codes? I have not been to successful in finding additional information about when to use the 33 modifier and if you can even use it on the labs. Our normal well child will be billed with a visit code (99381-99395), depression screenings (96161, 96110, or 96127), hemoglobin/finger stick (85018, 36416), fluoride treatment (99188), hearing/vision screen (99177, 99173, or 92551) and immunizations - Thank you in advance for all of your knowledge to help understand this modifier better.

 

[Cynthia Hughes]

We are starting to see an increase in patient responsibility being applied towards the hemoglobin (85018) and finger stick (36416) during the well child exam. Has anyone used modifier 33 with these codes? I have not been to successful in finding additional information about when to use the 33 modifier and if you can even use it on the labs. Our normal well child will be billed with a visit code (99381-99395), depression screenings (96161, 96110, or 96127), hemoglobin/finger stick (85018, 36416), fluoride treatment (99188), hearing/vision screen (99177, 99173, or 92551) and immunizations - Thank you in advance for all of your knowledge to help understand this modifier better.

You may want to first check a few of the payer policies for the charges that were applied to patient responsibility to see if the diagnosis codes reported are what is required (eg, link Z00.121, Z00.129, or Z13.0 to the test and finger stick codes). This could also be an error in the payer's system. However, it is possible that a payer is requiring modifier 33 since the codes may represent either preventive or diagnostic services.
Best wishes,
Cindy

diagnosis codes, diagnosis coding