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Thread Topic: Pathology Coding
Topic Originator: Marianne
Post Date January 22, 2015 @ 9:21 AM
Pathology Coding


Marianne
January 22, 2015 @ 9:21 AM Reply  |  Email Friend   |  |Print  |  Top

Hello,

I have a question regarding the use of a PT modifier on a pathology code 88305, for colon polyps, to indicate that the colonoscopy was a screening, but turned diagnostic due to the polyps. We often run into an issue where the insurance will pay at 100% for screening services, but when the pathologist receives a specimen of a colon polyp, our service is not screening, it is diagnostic. The patients will often question this as they think everything will be covered at 100%. Recently a patient contacted customer service and asked us to use a PT modifier. I am not sure if this is appropriate for the pathology charge, or if the modifier is intended only for the colonoscopy procedure itself. Any ideas?

Thanks!!
Marianne



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