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33 modifier for Colonoscopy

A

aschaeve

Guru
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161
Location
Fond Du Lac, WI
Can someone explain to me when to use the 33 modifier when billing for a Colonoscopy? Is it on any screening colonoscopy on only with codes G0105 and G0121?

Thank you,

Alicia, CPC
 
We are billing Medicare with the 33 and PT modifiers for our Anesthesia claims but we are getting denials. We are billing with the AA first ( when appropriate) and then PT or 33 and finally the QS. Medicare is denying the claims due to the modifiers according to the denial. We are waiting for Medicare to get out of a training session but I was wondering if anyone else has received denials for their January 2015 claims? Thanks for your assistance in advance.
 
If you are reporting separate anesthesia charges to Medicare, you will report the services with a 33 modifier if the screening did not turn therapeutic and a PT modifier if the screening did turn therapeutic. Reporting the different modifiers will tell Medicare whether they will waive the copay or not.
 
aschaeve said:
Can someone explain to me when to use the 33 modifier when billing for a Colonoscopy? Is it on any screening colonoscopy on only with codes G0105 and G0121?

Thank you,

Alicia, CPC
Click to expand...


http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/Downloads/MM8874.pdf

.... As a result, effective for claims with dates of service on or after January 1, 2015,anesthesia professionals who furnish a separately payable anesthesia service in conjunction with a screening colonoscopy (HCPCS code 00810 performed in conjunction with G0105 and G0121)shall include the following on the claim for the services that qualify for the waiver of coinsurance and deductible:
?


Modifier 33 ?
Preventive Services:
when the primary purpose of the service is the delivery of an evidence based service in accordance with a USPSTF A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.
 
afalcon@dhcla.com said:
If you are reporting separate anesthesia charges to Medicare, you will report the services with a 33 modifier if the screening did not turn therapeutic and a PT modifier if the screening did turn therapeutic. Reporting the different modifiers will tell Medicare whether they will waive the copay or not.
Click to expand...

The 33 and the PT are for use on non preventive codes when service was performed for preventive reasons. The 33 is for commercial payers for any service that meets the definition of a task force A and B preventive service. The PT is Medicare only and is used for no preventive colonoscopies. Such as the colonoscopy with polypectomy, when performed while the patient presented for a screening procedure. You will not use he G code for screening colonoscopy, you will use the polypectomy code and attach? the PT modifier for Medicare or the 33 for commercial.
 
The diagnosis code must be for a screening (V76.51) to use the 33 or PT modifiers. If the patient is having a colonoscopy, with any other primary diagnosis the claim will most likely deny.

Modifiers 33 & PT indicate a colon screening as a preventive service only.

If all they do is a colon screening, bill 00810-33.

If they do a colon screening & find something & do a biopsy or remove a polyp, bill 00810-PT.

Again, the primary diagnosis must be V76.51 for either of the above.

I received this information from the December 2014 Anesthesia & Pain Coder's Pink Sheet. If your employer doesn't subscribe, ask him/her to do so. They put out valuable information monthly that pertains to our specialty. (www.AnethesiaPain-Decisions.com)
 
We have also received denials from Medicare on our claims with the PT modifier. We bill for anesthesia providers across the country and it is happening with all of them. The claims deny as MA-130 unprocessable.

WPS medicare's modifier PT fact sheet does not list the anesthesia codes as valid CPT codes for this modifier.

Has anyone had a claim with modifier PT pd by Medicare?
 
missyah20: We've had many Colonoscopies billed with AA, QS, PT all deny from Medicare despite PT being listed in the Final Rule. There's another thread about this topic under the Modifiers section, too.
 
We have also had problems with the PT modifier on Medicare Anesthesia claims in Indiana and in Texas. The contractors will not adhere to the federal register's questions and comments section since it does not mention the PT anywhere in the actual ruling.
Two WPSMedicare reps have told us that they sent inquiry to CMS and are awaiting response from them.

I guess it is a waiting game for us.

In the meantime, we were directed to leave off the modifier and it WILL go to Patient Deductible and Copay instead of outright denials. How is this a correct way to bill??? We are baffled...:eek:

What about reporting to commercial insurances? Should we be billing 33 if the service started as a screening no matter the outcome? Or are they still not recognizing this modifier for anesthesia claims?

HELP!!!! :confused:


~Melissa
 
I have gotten the same update as above from Reps at NGS Medicare and WPS Medicare. I talked with a Rep from WPS this morning and she said that they have contacted Medicare and CMS is looking into it, but couldn't give me a time frame for any changes.
 
Does anyone know if they are doing an EGD/ colonoscopy combo and the colonoscopy part is diagnosed as a screening, can we still use the 33 and PT modifiers?
 
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