# MODIFIER PT VS MODIFIER 33 Screening Colonoscopy



## Ann Johnson (Jul 18, 2012)

DOES ANYONE HAVE A GOOD ARTICLE DESCRIBING THE DIFFERENCE BETWEEN MODIFIER PT - screening colonoscopy for Medicare pt switched to diagnostic aka therapeutic colonoscopy where pathology is taken  VERSUS MODIFIER 33 preventative service for commercial carrier.

I thought that PT was to be used for Medicare pts and that modifier 33 was to be used for commercial carriers to identify that a screening colonoscopy had been changed to a diagnostic therapeutic colonoscopy with pathology taken.

Would love to hear your thoughts on this issue.

Thanks
ASC Coder


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## jmcpolin (Jul 18, 2012)

Ann, is this modifier used only in an ASC?


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## nsteinhauser (Jul 19, 2012)

I don't have an article handy for the -33 but there's a "MLN Matters" addressing the -PT.  It's MLN Matters Number MM7012.  You can look them up at www.cms.gov.

Some of our commercial payors don't accept the -33.  Every policy is different.  Now we're also seeing commercial policies with higher coinsurance %'s for PREVENTIVE services versus diagnostic/therapeutic ... how irrational.  After getting used to patients calling and complaining that their colonoscopy wasn't 'coded correctly' because it wasn't coded as a screening (because it wasn't - they had symptoms) - now I have patients calling and complaining that I DID code it as a screening (because it was - there were no symptoms) and they have to pay more because it wasn't  a diagnostic/therapeutic procedure.


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