2015-04-10 16:46:06 UTC

New CMS Instructions on Use of PT Modifier with Anesthesia for Colonoscopy

April 10, 2015

CMS has clarified coding for anesthesia associated with screening colonoscopy.

CMS has issued an update to Preventative and Screening Services Transmittal MM8874 that removes references to coinsurance and deductible payments for anesthesia associated with screening colonoscopy. It also expands the range of services to which the PT modifier (CRC screening test converted to diagnostic test or other procedure) applies to include lower GI endoscopy anesthesia CPT code 00810.

Effective Jan. 1, 2015, when anesthesia service 00810 is performed in conjunction with screening colonoscopy services G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) or G0121 (Colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk), coinsurance and deductible will be waived for anesthesia service 00810 when modifier 33 is entered on the anesthesia claim. When a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia code 00810 should be submitted with the PT modifier and only the deductible will be waived.

This change addresses concerns that Medicare Administrative Contractors were denying claims for anesthesia for colonoscopies submitted with modifier PT, even though CMS directed providers to report screening colonoscopies that become diagnostic or therapeutic with that  modifier.

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