E-blast December 2010

2011 Gastroenterology Coding ALERT

From: Rhea Davis, CPC, RMC, RMM
Re: Screening colonoscopies that turn therapeutic

The start of the New Year brings a very exciting change for gastroenterologists; the addition of modifier “-PT”.

- PT is a Healthcare Common Procedure Coding System (HCPCS) modifier which has an effective date of January 1, 2011 and will be used for cases where a screening colonoscopy or flexible sigmoidoscopy was planned, but due to clinical findings, the procedure turned therapeutic.

The Center for Medicare and Medicaid Services (CMS) states the addition of this modifier will trigger the claim processing system to waive the deductible for all surgical services on the same date as the diagnostic procedure. Coinsurance, however, will still apply*.

Like many of you, I am anxious to see how claims will actually process with this modifier and if commercial payers will follow suit.

*Source, page 263:
http://edocket.access.gpo.gov/2010/pdf/2010-27969.pdf

Rhea Davis, a graduate of Florida State University, is a Practice Consultant at Galen Advisors, a Revenue Cycle Management company which focuses on practice improvement and increased revenue generation. Previous to Ms. Davis’ current role, she was a Senior Consultant at the Medical Management Institute and was the Central Business Office Manager for a 50+ doctor gastroenterology group in Atlanta, Georgia. You may contact Ms. Davis via email:
Rhea.Davis@GalenAdvisors.com