Wiki Colonoscopy Modifier(s)

[KoBee]

Hello,

I have to concerns,

1.) Should modifier PT or 33 be attach to all CPT codes or just main CPT code.

Example:
45385- 33
45380 - 33,59

or

45385-33
45880-59


2.) Also, should we be appending mod 33 to CPT 45378 when just a screening, or is the diagnosis Z12.11 enough to acknowledge that it is a screening.


Greatly appreciate that help!

 

[nickelclaw]

If patient comes in for a screening and goes into a diagnostic/therapeutic then mod PT should be on all the codes. The PT mod states that the screening turns into the later.
number two is correct for mod 33 otherwise insurance will think it is just a regular diagnostic colonoscopy.

 

[MarDee]

Hello,

I have to concerns,

1.) Should modifier PT or 33 be attach to all CPT codes or just main CPT code.

Example:
45385- 33
45380 - 33,59

or

45385-33
45880-59


2.) Also, should we be appending mod 33 to CPT 45378 when just a screening, or is the diagnosis Z12.11 enough to acknowledge that it is a screening.


Greatly appreciate that help!

Hi KoBee,

1. Yes, you should attach the modifier to each procedure. Modifier 33 for commercial insurances and Modifier PT for Medicare.
2. Yes again, you should always attach modifier 33 for screening with a commercial insurance and use Z12.11 dx. For Medicare use G0121 with Z12.11 if low risk (has no hx of polyps or family hx of polyps/ca) and use G0105 with Z86.010 for Medicare high risk (personal hx of polyps). HTH's.