Tammy Posted Thu 14th of July, 2016 08:32:04 AM
I understand which modifier to use for a screening colonoscopy resulting in a therapeutic scope. However, when multiple techniques (ex. snare in ascending colon with PT or 33 for 45385 with Z12.11 as primary dx followed by type of polyp diagnosis, but then cold bx. in transverse 45380...)what is the order of modifiers? Do I still use the PT or 33 as a primary modifier with 59 on the second therapeutic procedure? Or just 59? This seems to be a very grey area in all the researching I've done. Thank you.
SuperCoder Answered Fri 15th of July, 2016 05:02:30 AM
There can be two scenarios for the questions asked:
1.For Medicare- There is no CPT or CMS guidance about this question. It would be correct coding to do so. One would use the PT modifier first, when billing for Medicare.
2. For commercial insurance- If a screening colonoscopy converts to a diagnostic service, one would append modifier 33 and PT, in that order. Also, one would use modifier 33 in the first position for commercial payers, since it is a CPT modifier. It tells the payer that the service started as a preventive service and append modifier PT in the second position. Not all commercial payers may have this modifier in their system, but if they do, it explains the circumstances.
There are many services for which modifier 33 is correctly applied. Modifier PT is used only when a colorectal screening converts to a diagnostic or therapeutic service and as such, is more limited in its scope.
And, for the modifier 59, will be used if the services billed together are used on separate and distinct areas in the colon.
Hope this helps.