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Wiki Modifier pt versus 33
- Thread starter SDIGANGI
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- modifer 33 modifier pt
mitchellde
True Blue
From what I have read, PT is for Medicare and 33 is for all other payers.
Thank you, but as I was reading the other discussion regarding this modifier I see I am not the only one confused by how to use it correctly. My first thought was to use the PT modifier for Medicare and the 33 modifier for commercial insurance, but what confuses me is the wording in the example where is says "The most notable example of this is screening colonoscopy (code 45378), which results in a polypectomy (code 45383). As a certified gastro coder I know that the screening codes are G0121 and G0105 and that 45383 is an ablation code which is rarely used for polyp removal. Do we attach the 33 modifier the same as the PT which states this example (which makes sense to me), "a 68-year-old male patient, at high risk of colorectal cancer, undergoes a colonoscopy (G0105). Your physician finds and removes polyps during the screening. The physician reports 45380 and appends PT on the claim. Leave the V-code as the primary diagnosis and use the actual finding from the colonoscopy when listing a secondary diagnosis".
mitchellde
True Blue
to answer your final question yes that is how I am understanding it.
Both PT & 33 are used by Medicare as well as other payers.
PT is a modifier specifically for this purpose:
In the final rule, CMS created for Medicare a new Healthcare Common Procedure Coding System (HCPCS)modifier-PT (CRC screening test, converted to diagnostic test or other procedure) to the diagnostic procedure code that is reported instead of the screening colonoscopy or screening flexible sigmoidoscopy HCPCS code, or as a result of the barium enema when the screening test becomes a diagnostic service. The claims processing system would respond to the modifier by waiving the deductible for all surgical services on the same date as the diagnostic test. Coinsurance for Medicare beneficiaries would continue to apply to the diagnostic test and to other services furnished in connection with, as a result of, and in the same clinical encounter as the screening test.
PT is a modifier specifically for this purpose:
In the final rule, CMS created for Medicare a new Healthcare Common Procedure Coding System (HCPCS)modifier-PT (CRC screening test, converted to diagnostic test or other procedure) to the diagnostic procedure code that is reported instead of the screening colonoscopy or screening flexible sigmoidoscopy HCPCS code, or as a result of the barium enema when the screening test becomes a diagnostic service. The claims processing system would respond to the modifier by waiving the deductible for all surgical services on the same date as the diagnostic test. Coinsurance for Medicare beneficiaries would continue to apply to the diagnostic test and to other services furnished in connection with, as a result of, and in the same clinical encounter as the screening test.
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Does anyone know how to proceed when Medicare is secondary and the primary payer requires 33 instead of PT? Can I change the modifier on the secondary Medicare claim to PT?