Health Information Management

Tip: Differential between modifiers -33 and -PT

APCs Insider, May 6, 2011

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On the surface, modifier -33 (preventive service) and modifier -PT (colorectal cancer screening test; converted to diagnostic test or other ¬procedure) look the same, but they really aren't.

Modifier -PT is a HCPCS level II modifier, while the AMA introduced modifier -33 at the end of ¬December 2010.

Although both modifiers can be used for a colorectal cancer screening service that converts to a diagnostic service, modifier -33 designates all preventive services on the claim.

Consider the example of a male patient who comes in for a screening colonoscopy. During the screening, the physician finds something abnormal and performs a polypectomy. The service is now diagnostic. During the same visit, the physician performs a digital prostate exam.
In this example, both procedures started out as screenings, even though the colonoscopy became diagnostic. So coders would append modifier -33 to both codes. However, the digital prostate exam is not a surgical procedure, so ¬coders should not apply modifier -PT; that modifier only applies to surgical services.

The tip is adapted from “I/OCE edits: Look for bilateral status changes, new modifier” in the May issue of Briefings on APCs.



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