Reimbursement Roundup:
Modifier PT Helps Your Practice Capture Screening-Turned-Diagnostic Colonoscopy Pay
Published on Mon Jan 17, 2011
New modifier became effective Jan. 1 -- here's how you'll report it.The question of how to code a screening colonoscopy that becomes diagnostic during the course of the procedure -- and whether the patient's deductible applies -- has long puzzled some practices, but a new Medicare modifier solves that problem. Learn how modifier PT (CRC screening test converted to diagnostic test or other procedure) can solve your colonoscopy reimbursement woes.Get to Know Modifier PT BasicsEffective Jan. 1, Medicare carriers accept new modifier PT to explain when your physician starts a screening colonoscopy that then becomes a diagnostic procedure."This tells the MAC contractor that the service started as a screening procedure (e.g. G0105 [Colorectal cancer screening; colonoscopy on individual at high risk], G0121 [Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk]) but an abnormality was found and the procedure became diagnostic or therapeutic," says Joel V. Brill, MD, AGAF, CHCQM, [...]