Watch for payer definite rules for using the modifier.
You may be cheering the addition of a novel preventive services modifier in CPT manual 2012, nonetheless once you read the fine print, the "new" modifier might reflect "old" news. Read this expert medical coding article and take a step closer towards accurate CPT 2012 coding.
Tackle Preventive Services With Modifier 33
You'll see modifier 33 (Preventive services) printed in your 2012 CPT manual. It went into effect Jan. 1, 2011 but didn't make the deadline to get into the 2011 CPT manuals. Consequently, the code makes its first appearance in CPT® 2012, although you may have already reported it.
This modifier lets you tell your payer that you carried out a preventive service and that the patient's deductible and coinsurance do not apply in the new Patient Protection and Affordable Care Act (PPACA) rules.
Downside: Unfortunately, you're not expected to get any love from your MACs with this new modifier as Medicare does not recognize modifier 33
The reason? Medicare can simply pay for preventive services that are definitely legislated and all of these services have their individual "G" codes to describe them. You can merely place modifier 33 on a CPT® code.
Some insurers have information concerning modifier 33 on their Web sites. Few of them share quite a few guidelines for reporting modifier 33, including:
- CPT® modifier 33 applies to preventive services that do not have an exclusive code for such services (e.g., E&M codes such as, 99401 would not require modifier 33 as this code already indicates a preventive medicine service. However, code 99213 would require modifier 33 when the provider indicates that the service was preventive).
- In case multiple preventive medicine services are delivered on the same day, then the modifier is appended to the codes for each preventive service rendered on that day.
- Modifier 33 must be used when only preventive services were rendered on that date, not when together with other non-preventive services.
- CPT® codes acknowledged as inherently preventive, (e.g., screening mammography) must not be appended with modifier 33.
Find 90654 in the 2012 CPT Manual, Too
In case your urologist ever administers flu shots for patients, concentrate on 90654 (Influenza virus vaccine, split virus, preservative-free, for intradermal use). The AMA introduced code 90654 effective Jan. 1, 2011, but it was too late to make it into the 2011 CPT manual.
Check it out: CMS has already assigned a relative value to 90654 -- this flu season, you'll collect $18.383 in Medicare-equivalent payment for the preservative-free split virus for intradermal use.
CPT® 2012: Apply New Preventive Services Modifier 33