RE: Re: Need Coding Advice

[Guest guest]

According to a notice I received from BCBSGA, as of January 1 2011, they will expect preventative services submitted on a claim for payment to be identified with the new modifier indicating preventative services. This includes age appropriate wellness visits and immunizations along with any other preventative services performed. In addition if an E & M service is reported on the same DOS as a preventative service, the E & M service must be delineated with the -25 modifier to separate its reimbursement rates from that of the preventative services. The following is the description on the AMA site regarding the new -33 modifier for preventative services.PREVENTIVE SERVICES-33Preventive ServiceAlerts third-party payers that the procedure or service was preventive under applicable laws and that patient cost sharing (e.g., coinsurance, copayment, deductible) does not apply when furnished by in-network providers.EXAMPLE: The patient's primary care provider provided 20 minutes of smoking and tobacco use cessation counseling. Report code 99407-33.EXAMPLE: The patient underwent ultrasound bone density measurement and interpretation as a hospital outpatient. Report code 76977-33.EXAMPLE: The 54-year-old established female patient received level 2 office evaluation and management services from her primary care provider for chronic asthma. She also underwent total cholesterol lab testing during the encounter. Report codes 99212 and 82465-33. (Patient cost sharing applies to code 99212.)CODING TIP:When multiple preventive procedures or services are provided on the same day, add modifier -33 to each code.When procedure or service code descriptions contain the word screening (e.g., screening mammography), do not add modifier -33 to the code.NOTE:Modifier -33 was created by the AMA in January 2011 as a result of implementation of Patient Protection and Affordable Care Act (PPACA) regulations with the intent to require payers to cover 100% of certain preventive services and immunizations.Group health plans and/or other insurance issuers that existed on the date of enactment (March 23, 2010) are considered grandfathered plans. This means they are not required to comply with this PPACA regulation unless they choose to make significant changes that reduce benefits or increase costs to consumers.Out-of-network providers are not required to comply with this PPACA regulation, which means they can require patient cost sharing (e.g., coinsurance, copayment, deductible).Patient cost sharing is permitted for evaluation and management services when an office encounter and covered preventive services are reported separately and the primary purpose of the office visit is not provision of covered preventive services.CPT modifier -33 is added to preventive procedures and/or services without patient cost sharing in four categories: Preventive services rated A or B by the United States Preventive Services Task Force (USPSTF), which is updated annually at http://www.uspreventiveservicestaskforce.org.Immunizations for routine use in children, adolescents, and adults that are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.Preventive care and screenings for children that are recommended by Bright Futures (American Academy of Pediatrics) and Newborn Testing (American College of Medical Genetics), as supported by the Health Resources and Services Administration (HSRA).Preventive care and screenings provided for women, which are not included in USPSTF recommendations, but which are included in comprehensive guidelines supported by HSRA. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of sharkinnSent: Sunday, April 15, 2012 1:03 PMTo: Subject: Re: Need Coding Advice I just always use the 25 modifier, and it has never caused any problems. Seems easier than knowing who wants it and who doesn't.---Sharlene>> I recently learned from a patient that BC/BS throws out either the preventive services (check-up) code or the immuniZation administration code, whichever is the greater $'s, when they are used together. I solved the problem by adding modifier 25 to the preventive services code, allowing both codes to be processed by their computer.> > Aren't these two codes intended to be used together without any modifiers? Will I cause more problems than fewer by adding mod 25 to the prev serv code routinely when I use the fax admin code in addition when I give vaccines?> > Thank you,> > Marc Tanenbaum, MD> Atlanta>

[Guest guest]

I had gottten notice from CDPHP about this but seems will have to do this for all insurances. I've think I'll have to add it to quick codes somehow. What I don't see is the codes that show I recommended it but patient refused so I don't get my wrists slapped on quality measures. It takes me longer to write the note and code than it does to see the patient! To: Sent: Sunday, April 15, 2012 2:26 PM Subject: Re: Need Coding Advice

OH GREAT!!! Another thick layer of added complexity that makes more junk for us to remember and do and more opportunity for the payers to refuse to pay and patients to get upset if we make a mistake! Just when you think it really couldn't get much worse...! Oh, how I wish I could afford to just throw in the towel...Sharlene

> >

> > I recently learned from a patient that BC/BS throws out either the

> preventive services (check-up) code or the immuniZation administration code,

> whichever is the greater $'s, when they are used together. I solved the

> problem by adding modifier 25 to the preventive services code, allowing both

> codes to be processed by their computer.

> >

> > Aren't these two codes intended to be used together without any modifiers?

> Will I cause more problems than fewer by adding mod 25 to the prev serv code

> routinely when I use the fax admin code in addition when I give vaccines?

> >

> > Thank you,

> >

> > Marc Tanenbaum, MD

> > Atlanta

> >

>