1. Vickie Beck
   Posted 9 months ago #
   

   Established Pt.w/rectal cancer, who is a smoker,returns for 6 mth OV. PET scan done in 02/11 shows chronic inflammatory changes in right upper lobe of lung and pelvis. No evidence of malignancy.
   Dr. spent greater than 3 minutes for smoking cessation and prescribed medication to control smoking. E/M codes 99214 and 99406 are used for this OV. Should a modifier 33 be applied to code 99406?

2. SuperCoder
   Posted 9 months ago #
   

   Yes, we should use modifier 33 with CPT 99406. Analysis as follows:-

   ***
   Only specific screening services require modifier 33 and those services only require the modifier when they are
   provided during a visit whose primary purpose is not preventative.

   ***
   If the patient comes in for a problem visit and during the visit you provide an A or B rated screening
   service or immunization from the US Preventive Services Task Force, that service would have modifier 33
   appended to indicate to the payer that no cost-sharing is applicable to the screening service.

   ***
   Medicare covers counseling for tobacco cessation for outpatients and for inpatients. Inpatients are covered
   only if counseling for tobacco use is not the primary reason for the patient’s hospital stay. Medicare covers 2
   cessation attempts per year. Cessation counseling benefits are for individuals who:
   1. Use tobacco and have been diagnosed with a recognized tobacco-related disease, Or,
   2. Use tobacco and exhibit symptoms consistent with a tobacco-related disease

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