PT Modifier Question

[MedCoder51]

On a recent audit, I had a deduction for the use of the PT modifier. Question: Do any of you use the PT modifier for Medicare procedures only that are screenings that transition to therapeutic? I was told to use the modifier for ALL such procedures, regardless of Medicare, or not.

 

[LisaAlonso23]

For Medicare only, the ASA code will change from 00812 to 00811, but the modifier PT is appended for all payors when a screening becomes diagnostic resulting in a procedure.

 

[MonicaDay]

Agreed, the PT Modifier is only used for a screening to diagnostic colonoscopy for MCR - no other insurances use this modifier.

 

[andavis234]

we have a denial for 45385 and the insurance company (NOT Medicare) is requesting PT modifier to be added- is there a different modifier other than PT for this circumstance? thank you in advance.

 

[andavis234]

Agreed, the PT Modifier is only used for a screening to diagnostic colonoscopy for MCR - no other insurances use this modifier.

we have a denial for 45385 and the insurance company (NOT Medicare) is requesting PT modifier to be added- is there a different modifier other than PT for this circumstance? thank you in advance.

For Medicare only, the ASA code will change from 00812 to 00811, but the modifier PT is appended for all payors when a screening becomes diagnostic resulting in a procedure.

 

[lr09050828@gmail.com]

On a recent audit, I had a deduction for the use of the PT modifier. Question: Do any of you use the PT modifier for Medicare procedures only that are screenings that transition to therapeutic? I was told to use the modifier for ALL such procedures, regardless of Medicare, or not.

I do not use the PT modifier...just the AA or QK/QX and P status and QS since we use MAC.

 

[LisaAlonso23]

we have a denial for 45385 and the insurance company (NOT Medicare) is requesting PT modifier to be added- is there a different modifier other than PT for this circumstance? thank you in advance.

If the purpose of the colonoscopy was a screening and it resulted in a procedure the coding would be:
45385/00812-PT Z12.11 followed by the DX code for finding (for commercial insurance)
45385/00811-PT Z12.11 followed by the DX code for finding (for Medicare and Medicare Advantage Plans)

Some plans have specific requirements. BCBSTX requests modifier 33 for the above scenario.

 

[bkosman]

Brushing up on colonoscopy coding. What ASA would you use for a Medicare patient who had a screening colonoscopy turned diagnostic as well as an EGD - 00811, 00812 or 00813? We recently started adding the PT modifier to the ASA as well in these scenarios. Thanks for feedback and guidance!