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PT and 33 modifier with Z86.010

Susan Posted Thu 13th of September, 2018 10:49:58 AM
Please help clarify this issue, Patients that are coming back in for their surveillance/screening due to history of polyps Z86.010, we use G0105 with z86.010 for medicare and private insurers. However, if biopsies are taken or a polyp removed then we code the appropriate cpt code but do not append the PT for medicare or the 33 for private if procedure was for Z86.010. We have been doing this for some time now and now told the using the 33 or PT on procedure being done for personal history of polyps is fragulent. Please help!!!!!!
SuperCoder Answered Fri 14th of September, 2018 07:46:41 AM

Hi Susan,

Thank you for your Question.

When a screening colonoscopy becomes a diagnostic colonoscopy, screening colonoscopy CPT code with PT modifier would be billable; only the deductible is waived.

 

When the physician discovers an abnormality during a screening and performs a biopsy or procedure, then services are no longer dealing with a screening. colonoscopy CPT® code that represents the service, such as a colonoscopy with biopsy CPT® code would be appropriately billable.

 

For Medicare and those payers following Medicare rules, you should append modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure) to the procedure code for colonoscopy to show the patient presented for a screening.

 

Modifier 33 – Preventive Services: when the primary purpose of the service is the delivery of an evidence based service in accordance with a USPSTF A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.

Hope this helps!

 

 

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