# PT Modifier Question



## MedCoder51 (May 20, 2021)

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.


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## LisaAlonso23 (May 20, 2021)

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.


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## MonicaDay (May 20, 2021)

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


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## andavis234 (Nov 3, 2021)

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.


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## andavis234 (Nov 3, 2021)

MonicaDay said:


> 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.


LisaAlonso23 said:


> 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.


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## lr09050828@gmail.com (Mar 3, 2022)

MedCoder51 said:


> 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.


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## LisaAlonso23 (Mar 3, 2022)

andavis234 said:


> 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.


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