Following reports that some CMS carriers were not recognizing the -PT modifier for ASC claims, the Ambulatory Surgery Center Association is reporting the carriers are now beginning to process these claims correctly.
CMS informed ASCA on Feb. 7 that it was issuing private clarifications and instructions to its carriers to correct the processing errors. The ASCA has confirmed with its members that correct processing is now taking place.
The -PT modifier should be used when a patient is scheduled for a Medicare-covered screening colonoscopy, but discovery of a polyp or other indicator leads the physician to change to a diagnostic colonoscopy, according to a report on the ASCA website.
"Medicare will waive the patient's deductible for the diagnostic colonoscopy performed on the same day that a screening colonoscopy was scheduled," according to the report. "The patient, however, is responsible for the co-pay for the diagnostic colonoscopy. In the case where a patient's screening colonoscopy remains a screening colonoscopy, both the patient's co-pay and deductible will be waived and no additional modifier is needed."
Read the report from the ASCA on the PT modifier (pdf).
Learn more about the ASC Association.
Read more about the ASC Association:
- New Head of ASC Association William Prentice Shares Thoughts on the Industry
- ASC Association Announces 2011 National ASC Open House Day
- Medicare Clarifies Same-Day History and Physical Guidance for Surgery Centers