Wiki Surveillance colonoscopy -33 modifier

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bridgettemartin

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In regards to the March Cutting Edge article "Screening or Surveillance":
Based upon this article and its' references, if a commercial patient presented for a surveillance colonoscopy d/t a personal hx polyps, would you/would you not append the 33 modifier to the claim? (45378-33/V12.72 vs. 45378/V12.72)
 
Thanks for your repsonse Erica.

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So according to AAPC, ICD9 guidelines do not allow V76.51 with V12.72.

The article in Cutting Edge identifies "preventive colonoscopy screenings" to include patients that do not have any personal history of colon cancer, polyps, or GI disease.

The 33 modifier is applicable to preventiative services. We've been appending this to all patients considered high risk (personal history, familiy history etc.). So does this mean we've been appending it incorrectly? This doesn't seem to make sense. I guess I'm caught up in the fact that the patient is asymptomatic.

A few months ago, a local hospital told me I need to just send orders over for screening instead of personal history of polyps if we want them to bill out the procedure with a modifier 33. They only append this modifier to V76.51. So the facility claim is hitting the patient's deductible while the physician (which we bill for) is getting paid in full and the patients are calling the hospital upset.

Hope to hear others regarding this topic.
 
Kisalyn,

Are you asking about 33 and not applying it to scopes w/V12.72 because that scope would be considered a surveillance? To me when you read the information the AMA has put out on modifier 33, this applies to screening colonoscopies, the issue is really when you get to the payer; it all depends on how they are going to process based on the diagnosis codes. If you really wanted to know whether to append the modifier 33 it would be necessary to contact the payer and ask them how they view a claim coded as 45378 with a dx of V12.72. If they view it was a diagnostic procedure (i say that b/c they are not going to tell you surveillance) or screening/routine. If they tell you screening I would append the 33 if it turns to polypectomy, if they tell you diagnositc there would be no reason to append the modifier 33 since the payer is not viewing this as a screening/preventative service.
 
The 33 mod is essentially the same as the PT mod for Medicare. Use 33 when a screening/surveillance procedure has turned diagnostic. I append 33 to 45385, 45380, etc. I would not use it for 45378. A lot of commercial payers do accept the PT modifer though. Anthem in particular wants the PT not the 33. I've just been experimenting with our various payers to see which they prefer.
 
egraham1827 said:
The 33 mod is essentially the same as the PT mod for Medicare. Use 33 when a screening/surveillance procedure has turned diagnostic. I append 33 to 45385, 45380, etc. I would not use it for 45378. A lot of commercial payers do accept the PT modifer though. Anthem in particular wants the PT not the 33. I've just been experimenting with our various payers to see which they prefer.
Click to expand...

According to the AAPC Physician services:
The AMA created modifier 33 Preventive Service to alert an insurer that the provider is billing a service covered under the Patient Protection and Affordable Care Act (PPACA), for which patient cost sharing does not apply.

33 modifier is used to show a service was "preventative", irregardless if any therapeutic services were provided. It is not used when the CPT code being submitted is inherently a screening code. (like Medicare's G0121). CPT code 45378 is not inherently a screening code, so modifier 33 should be appended if it was a screening service.
This is different from medicare's modifier PT, which is only appended to screening services that become therapeutic.

Back to my original question: Are other coders appending modifier 33 to surveillance colonoscopies?
 
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