New GI Modifier -PT Takes Effect January 1

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A new HCPCS modifier takes effect Jan. 1, 2011, for use in cases where a screening colonoscopy or screening flexible sigmoidoscopy was planned, but clinical findings leads to a diagnostic colonoscopy, according to the Ambulatory Surgery Foundation.

Modifier –PT will “prompt the claims processing system to waive the deductible for ALL surgical services on the same date of service as the diagnostic service,” according to the ASF. “Unlike the additional waiver of copayments and coinsurance for straight screening services allowed by the Patient Protection and Accountable Care Act, if the planned screening service becomes a diagnostic service, only the deductible is waived.”

The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

Learn more about Ambulatory Surgery Foundation.

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– 5 Steps to Audit Your Coding Process

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