Anesthesia Coding Alert

Question: On a recent audit, I had a deduction for the use of the PT modifier. I’ve been told to use the modifier for all screenings that transition to therapeutic, regardless of whether the patient has Medicare. Is that not correct?

Oklahoma Subscriber

Answer: The PT modifier (Colorectal cancer screening test; converted to diagnostic test or other procedure) is only used for a colonoscopy that shifts from screening to diagnostic for Medicare patients; no other insurers use this modifier. The anesthesia code also will change for Medicare, (but may not change for other payers) from 00812 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy) to 00811 (… not otherwise specified). Follow the instructions in CPT^® for payers other than Medicare, unless there is specific policy indicating the insurance company follows Medicare guidelines.