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Modifier pt versus 33

  1. Default Modifier pt versus 33
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    DOES ANYONE KNOW THE DIFFERENCE BETWEEN MODIFIER PT AND MODIFIER 33?

  2. #2
    Location
    Columbia, MO
    Posts
    12,570
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    From what I have read, PT is for Medicare and 33 is for all other payers.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    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".
    Sheila DiGangi,CGCS
    Certified Gastroenterology Coding Specialist
    Bayfront Digestive Disease Associates
    100 Peach St. Ste 200
    Erie, PA 16507
    814-456-7733 Ext. 117
    814-456-7213 Fax
    sdigangi@bayfrontgi.com

  4. #4
    Location
    Columbia, MO
    Posts
    12,570
    Default
    to answer your final question yes that is how I am understanding it.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    Thank You!!
    Sheila DiGangi,CGCS
    Certified Gastroenterology Coding Specialist
    Bayfront Digestive Disease Associates
    100 Peach St. Ste 200
    Erie, PA 16507
    814-456-7733 Ext. 117
    814-456-7213 Fax
    sdigangi@bayfrontgi.com

  6. Default
    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.

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