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Modifier PT versus Mod 33

  1. Default Modifier PT versus Mod 33
    Medical Coding Books
    I need help on the definitions of Modifier PT? Also, has anyone had success with using the Modifier 33?

  2. #2
    Default
    The Modifer PT denotes a prevenative service that was converted to diagnostic. Here's the MLN article: http://www.cms.gov/MLNMattersArticle...ads/MM7012.pdf

    We've only been appending modifier 33 to carriers that have uploaded the modifier to their systems. I imagine most carriers won't update their systems until the end of this year or beginning of next year.

    Edit: Also, most are probably already aware of this, but PT is for Medicare and 33 is for commercial insurances.
    Last edited by Kisalyn; 05-09-2011 at 11:17 AM. Reason: Add clarification

  3. Default
    Thnak you so much for your time. Have a great day.

  4. Default
    Just to clarify a little more on pt vs. 33 modifier. The 33 modifier is for preventative services in general and pt is specific for colorectal cancer screenings that turn diagnostic. We have found that some commercial insurances are still processing to the deductible because their system is not set up properly to accept the pt modifier yet.
    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

  5. Default
    Do you list the 33 modifier if the patient comes in with history of polyps and nothing is found?

    Marci

  6. Default
    If the patient is coming in because of a hx of polyps and nothing is found, you dont need any modifier. You code g0105 with v12.72. If the physician would have done anything therapeutic (ex. Remove polyp, ablate lesion, etc.) then you would append the modifier.
    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

  7. #7
    Location
    Atlanta Perimeter
    Posts
    59
    Default
    Some commerical carriers are now accepting the PT modifier for screening colonoscopies that convert to surgical due to the findings (polyps being biopsied or removed). BCBS of GA is one. Also, Humana Gold Choice (Mcare replacement) is accepting it.

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