Wiki KJ

[kjonesaapc]

PT Modifier

I'm doing GI endoscopy coding for an ASC. I think I'm clear on when to attach the PT modifier. I need to know how to arrange the dx codes when using it. My understanding was that you would list findings first and then indications (i.e. the V code would come last) However, some commercial payers are telling me they need to see the V code first regardless of the fact that there is a PT modifier. Can anyone point me in the right directions on this? Thank you!

 

[bethh05]

If it was for a screening the V76.51 would be the primary diagnosis. If the patient is high risk (family history or history of polyps, etc) you would use the V16.0 or V12.72 as primary diagnosis then V76.51 second, with the findings to follow. Also, the PT modifier is a Medicare modifier and 33 modifier is for commercial payers.

 

[kjonesaapc]

If it was for a screening the V76.51 would be the primary diagnosis. If the patient is high risk (family history or history of polyps, etc) you would use the V16.0 or V12.72 as primary diagnosis then V76.51 second, with the findings to follow. Also, the PT modifier is a Medicare modifier and 33 modifier is for commercial payers.

Thanks Beth. Just to clarify: For ASC coding, can I use mod 33? It's not listed in CPT as approved for ASC. Thanks so much.

 

[bethh05]

33 modifier is used in an ASC. We had some issues at first, but all the commercial carriers have been accepting the modifier.