Wiki Modifier PT versus Mod 33

[jlaird]

I need help on the definitions of Modifier PT? Also, has anyone had success with using the Modifier 33?

 

[Kisalyn]

The Modifer PT denotes a prevenative service that was converted to diagnostic. Here's the MLN article: http://www.cms.gov/MLNMattersArticles/downloads/MM7012.pdf

We've only been appending modifier 33 to carriers that have uploaded the modifier to their systems. I imagine most carriers won't update their systems until the end of this year or beginning of next year.

Edit: Also, most are probably already aware of this, but PT is for Medicare and 33 is for commercial insurances.

 

[jlaird]

Thnak you so much for your time. Have a great day.

 

[SDIGANGI]

Just to clarify a little more on pt vs. 33 modifier. The 33 modifier is for preventative services in general and pt is specific for colorectal cancer screenings that turn diagnostic. We have found that some commercial insurances are still processing to the deductible because their system is not set up properly to accept the pt modifier yet.

 

[Mklaubauf]

Do you list the 33 modifier if the patient comes in with history of polyps and nothing is found?

Marci

 

[SDIGANGI]

If the patient is coming in because of a hx of polyps and nothing is found, you dont need any modifier. You code g0105 with v12.72. If the physician would have done anything therapeutic (ex. Remove polyp, ablate lesion, etc.) then you would append the modifier.

 

[eescalante]

Some commerical carriers are now accepting the PT modifier for screening colonoscopies that convert to surgical due to the findings (polyps being biopsied or removed). BCBS of GA is one. Also, Humana Gold Choice (Mcare replacement) is accepting it.