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Regional Carriers Processing PT Modifier Claims Correctly Following ASC Association Intervention

The ASC Association has determined that members affected by improper processing of claims using PT modifiers are now reporting correct processing, following ASC Association intervention and assistance.

In mid-January, ASCA members across the country notified ASCA that claims they were billing using a PT modifier were being rejected by their regional carriers. The carriers were giving a variety of explanations for the denials. ASCA contacted CMS about the denials and spent time talking with CMS officials and sharing examples of claims denials from various carriers.

On Feb. 7, 2011, ASCA was informed that CMS was issuing private clarifications and instructions to carriers to correct the claims processing errors. After following up with affected ASCA members, ASCA determined that carriers are beginning to process claims correctly.

ASC billers should use the PT modifier when a patient is scheduled for a Medicare-covered screening colonoscopy, but the provider finds a polyp or indicator that changes the procedure to a diagnostic colonoscopy.

Read the ASC Association release on PT modifiers.

Related Articles on the ASC Association:
Bottoms Up: Screening Colonoscopy Coding From a Coder's Perspective
Rep Joe Heck: Physicians Should Receive Tax Credit for Uncompensated Care
CMS Gives State Medicaid Agencies Expanded Access to Medicare Data

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