Modifier PT for Colonoscopy being denied by CMS

Billing500

Networker
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All of our anesthesia claims are being denied by Medicare when billing:
00810 AA QS PT
The 33's are being paid correctly.

The "senior CMS rep" has directed me to a January 2015 Release - Part B document which only calls for modifier 33 to be used for anesthesia associated with screening colonoscopy. She further said that only the provider doing the actual colonoscopy should be billing with a PT.

I've seen many other sites (including some fairly well known anesthesia sites), which list PT as the modifier which should be used in cases where polyps were removed or a biopsy was taken.

Has anyone else had trouble with denials when using modifier PT??
 

LisaAlonso23

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Sherman, TX
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PT shows the colonoscopy was done as a screening. Most of the documentation out there addresses -33 but not PT when it comes to Anesthesia. The Pink Sheet, which addresses only Anesthesia & Pain Management, recently put out an article addressing both modifiers. It was my understanding we are to use both for screenings when the ICD-9 is V76.51. We just started using these modifiers, so I have seen denials...yet. I recommend you to the Federal Registery and print out the information regarding these modifiers to submit with your appeal.
 

Billing500

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Thanks. The Medicare rep actually told us to use 33 modifier only for all screening, regardless of whether it included removal of polyps, etc. Please keep me posted if Medicare denies your claims with -PT, too!
 

dustikins

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This is from the MLN on Jan 8th. My understanding is the -PT is no longer used for anesthesia claims, only the -33 when it starts as a screening and converts to a diagnostic. Hopes this helps!


Anesthesia Furnished in Conjunction with Colonoscopy Section 4104 of the Affordable Care Act defined the term ?preventive services? to include ?colorectal cancer screening tests? and as a result it waives any coinsurance that would otherwise apply under Section 1833(a)(1) of the Act for screening colonoscopies. In addition, the Affordable Care Act amended Section 1833(b)(1) of the Act to waive the Part B deductible for screening colonoscopies. These provisions are effective for services furnished on or after January 1, 2011. In the CY 2015 PFS Proposed Rule, CMS proposed to revise the definition of ?colorectal cancer screening tests? to include anesthesia separately furnished in conjunction with screening colonoscopies; and in the CY 2015 PFS Final Rule with comment period, CMS finalized this proposal. The definition of ?colorectal cancer screening tests? includes anesthesia separately furnished in conjunction with screening colonoscopies in the Medicare regulations at Section 410.37(a)(1)(iii). As a result, beneficiary coinsurance and deductible does not apply to anesthesia services associated with screening colonoscopies. 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.
 
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