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Coding rules for Modifier 32 and 33

There are modifiers in medical coding which are used very rarely. Modifier 32 and 33 are some of these modifiers which are used only when there is a clear documentation for coding these modifiers. We have already discussed about modifier 22, 23, 24 and 25 previously. Also, you can checkout the list of  modifiers in medical coding which we are using everyday. But, today we will try to learn about Modifier 32 and Modifier 33 only.

Coding rules for Modifier 32 and 33

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When to use Modifier 32

Mandated Services

Modifier -32 indicates a service that is required by a third-party entity, Worker’s Compensation, or some other official body. Modifier 32 is no used to report a second opinion request by a patient, a family member or another physician. This modifier is used only when a service is mandated.  For example, an insurer requests an independent evaluation of a patient filing a workers’ compensation claim or an insurer seeks a second opinion on a patient’s condition, prior to authorizing further testing and/or treatment. But do remember the second opinion requested by the patient, or the patient’s family, do not qualify for modifier 32. Neither is modifier 32 used for a consultation with another physician, or when another physician evaluates a patient for medical clearance prior to a procedure. Also, the Medicare generally do not accept modifier 32 and does not pay for the service requested by another provider. So use Modifier 32 only for private or commercial payers.

The third-party payer usually waives the deductible and co-payment for the patient and pays 100% of the service.

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When to use Modifier -33

Preventive Service

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Modifier -33 was developed by the American Medical Association (AMA) in response to The Patient Protection and Affordable Care Act (PPACA), which requires health insurers to cover preventive services and immunizations without any cost sharing. Modifier -33 gives providers a way to identify preventive services that do not have a unique CPT code. This modifier also indicates to the payer that it might be appropriate to waive any deductible associated with coinsurance or copayment. This modifier may be used to identify a preventive service that begins as diagnostic, but must be converted to a therapeutic service.

Modifier -33 is applicable in these four categories:

  1. US Preventive Services Task Force (USPSTF) grades preventive services:

Grade A: have been judged to have a high certainty that the net benefit is   substantial. 

Grade B: been judged to have a high certainty of moderate to substantial net benefit.

  1. Routine immunizations (children, adolescents, and adults), as recommended by the Advisory Committee on Immunization Practices for Disease Control and Prevention.
  2. Preventive care and screenings for children, as 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.
  3. Preventive care and screenings provided for women (not included in the Task Force recommendations) in the comprehensive guidelines supported by the Health Resources and Services Administration.                                                                                                                                                                                                                                                           Read also: Best coding tips for Thyroid uptake and Imaging   

Point to remember with Modifier 33

Do not use modifier 33 with Medicare insurance, use this modifier only with private or commercial payers. Medicare do not accept modifier 33.

When a physician provides multiple preventive medical services to the same patient on same day, use modifier 33 to the codes describing preventive service for that day.

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