The Center for Medicare & Medicaid Services (CMS) recently announced that effective Jan. 1, 2015, the following modifiers are required for Anesthesia Furnished in Conjunction with Screening Colonoscopy.
In the MLN Matters® MM8874, CMS speaks to the use of modifier 33:
“Section 4104 of the Affordable Care Act defined the term ‘preventive services’ to include ‘colorectal cancer screening tests’ and as a result it waives any coinsurance that would otherwise apply under Section 1833(a)(1) of the Act for screening colonoscopies. In addition, the Affordable Care Act amended Section 1833(b)(1) of the Act to waive the Part B deductible for screening colonoscopies. These provisions are effective for services furnished on or after Jan. 1, 2011.1
“In the CY 2015 PFS Proposed Rule, CMS proposed to revise the definition of ‘colorectal cancer screening tests’ to include anesthesia separately furnished in conjunction with screening colonoscopies; and in the CY 2015 PFS Final Rule2 with comment period, CMS finalized this proposal. The definition of ‘colorectal cancer screening tests’ includes anesthesia separately furnished in conjunction with screening colonoscopies in the Medicare regulations at Section 410.37(a)(1)(iii). As a result, beneficiary coinsurance and deductible does not apply to anesthesia services associated with screening colonoscopies.”3
“As a result, effective for claims with dates of service on or after Jan. 1, 2015, anesthesia professionals who furnish a separately payable anesthesia service in conjunction with a screening colonoscopy (HCPCS code 00810 performed in conjunction with G0105 and G0121) shall include the following on the claim for the services that qualify for the waiver of coinsurance and deductible:
- Modifier 33 – Preventive Services: when the primary purpose of the service is the delivery of an evidence based service in accordance with a USPSTF A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.”4
The PFS Final Rule went on to state: “In situations that begin as a colorectal cancer screening test, but for which another service such as colonoscopy with polyp removal is actually furnished, the anesthesia professional should report a PT modifier on the claim line rather than the 33 modifier”5.
Due to the way screening colonoscopies must now be reported, it is important that the correct diagnosis be documented by the provider.
- When the charge is documented as a screening and there are NO findings, there are NO signs or symptoms:
- 4537800810-33 (Modifier) and primary ICD-9 V76.51
- Charge is documented as a screening however something is found (for example surgeon performs a polypectomy)
- 4538000810-PT (Modifier), ICD-9 V76.51, 211.3