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New Modifier for Screening to Diagnostic / Therapeutic Colonoscopy

  1. #1
    Default New Modifier for Screening to Diagnostic / Therapeutic Colonoscopy
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    The 2011 Medicare Physician Fee Schedule Final Rule, published earlier this month has provided a new modifier to use when a screening colonoscopy becomes diagnostic or therapeutic The modifier "PT" will be used on the diagnostic code and the claims processing system will process the service with the screening benefits. Addendum: The information is in the Federal Register at this link, page 73431, page 263 of the document. Note: This is a huge file and takes awhile to download.

    http://edocket.access.gpo.gov/2010/pdf/2010-27969.pdf
    Last edited by j.berkshire; 12-10-2010 at 07:24 AM. Reason: new link.
    Jenny Berkshire, CPC, CEMC, CGIC

  2. Default :)
    Hi j.

    Thanks for the vital info. But the link you have provided is not working. I have downloaded Federal register from CMS site buit that is only of 692 pages, so not able to find anything about PT modifier.

    Please help.

  3. #3
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    Here is the info:

    "What’s New: CPT® Coding Changes for 2011 — 3
    Medicare CRC Screening: Diagnostic Modifier-PT
    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."

  4. #4
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    So, my question would be, would you still need to include the screening dx on the diagnostic procedure as primary, but still point to the diagnostic dx ie:211.3, or will the modifier leave us without the need to put the sx dx on the claim? Does anyone know?

  5. #5
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    You should still code the screening dx first and then point both to the CPT code.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    That seems kind of redundant, to put the sx dx and the modifier showing that it started off as a screening, but I guess MCR is good at coming up with things that don't totally make the most sense! Thanks for the help on that Debra! :0)

  7. Default
    I think the screening code would be dropped as it would with a screening colonoscopy becoming diagnostic with medicare. I believe the finding would become principal diagnosis.

  8. #8
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    No it still specifies that we use the screening dx as the first listed dx that has not changed.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
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    It is my understanding that the PT modifier is appended so that the deductible is waived for the Medicare patient. Everything else that we do would remain the same as far as V76.51 being the primary diagnosis code. If a snare and biopsy are performed, the PT modifier would have to be appended to one of the codes (most likely 45385 since 45380 would get the 59 modifier). Nothing here to make our lives easier just to help the patient.
    JOJO-CPC-H

  10. #10
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    I think you will need the PT on Both codes, put it after the 59 on the second code.

    Debra A. Mitchell, MSPH, CPC-H

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