What is the difference between PT and 33?

Asked by: Emil Gutkowski  |  Last update: January 6, 2026
Score: 4.4/5 (25 votes)

For Medicare patients, add PT modifier to the code to indicate that this procedure began as a screening test. For patients with commercial insurance, add modifier -33.

When to use modifier 33 and PT?

While modifier PT is specific to colorectal screenings converted to diagnostic or therapeutic services, modifier 33 broadly applies to any ACA-designated preventive service with a commercial payer.

What is the PT modifier used for?

The –PT modifier indicates a screening colonoscopy has been converted to a diagnostic test or other procedure.

What is the difference between surveillance and screening colonoscopy?

Diagnostic colonoscopies, also referred to as follow-up or surveillance colonoscopies, are different from screening colonoscopies since such procedures are provided when there is a greater probability of cancer development or if there is evidence that colorectal cancer might be present.

What is the difference between a Proctosigmoidoscopy and a colonoscopy?

Proctoscopy examines the anus and rectum, while a colonoscopy uses a colonoscope to view the entire colon. Like the proctoscope, a colonoscope is a thin, hollow tube that's inserted in the anus.

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33 related questions found

Why would the doctor do a sigmoidoscopy instead of a colonoscopy?

A flexible sigmoidoscopy is a quick, safe and efficient way for healthcare providers to diagnose and treat conditions in your lower large intestine. It doesn't go as far into your body as a colonoscopy, so it doesn't take as much time or preparation. It can be done with or without sedation.

How much does a Proctosigmoidoscopy test cost?

The sigmoidoscopy test price ranges from around INR Rs. 1500/- to INR Rs. 35000/-, depending on factors such as the patient's condition and the type of procedure. It is advisable to consult a doctor who can provide information about the procedure, its associated costs, and potential side effects.

What is the average number of polyps removed during a colonoscopy?

The mean number of polyps detected at baseline colonoscopy was 20.0 ± 22.8 (median 13, range 10–200). According to these, 16.0 ± 12.3 (median 13, range 10–147) were endoscopically resected. The mean size of the largest polyp was 13.4 ± 6.3 mm (median 12.0 mm, range 3.0–40.0 mm).

Is a colorectal screening as good as a colonoscopy?

The DNA stool test is less sensitive than colonoscopy at detecting precancerous polyps. If abnormalities are found, additional tests might be needed. The tests can suggest an abnormality when none is present (false-positive result).

Does insurance cover colonoscopy if polyps are found?

with colon polyps or colon cancer. Your insurance should cover 100% of the costs, so you will not need to pay.

How often does Medicare pay for a colonoscopy?

Medicare covers screening colonoscopies once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy. There's no minimum age requirement.

How to bill a colonoscopy with poor prep?

The failed procedure is billed and paid using CPT® code 45378, HCPCS code G0105 or G0121, or CPT® code 44388, if attempting to perform the colonoscopy through an existing stoma. Modifier “-53” (discontinued procedure) must be appended to any procedure code submitted when billing for a failed colonoscopy attempt.

What qualifies as a screening colonoscopy?

Screening Colonoscopy

A colonoscopy is considered screening when: You've had no lower gastrointestinal signs or symptoms before the colonoscopy. No polyps or masses are found during the colonoscopy. There's no family history of polyps or colon cancer.

What modifier is used for PT?

The GP modifier is used in any case where the rendering provider is a physical therapists. If physical therapist provides a therapeutic exercise (CPT code 97110) in an outpatient setting, they would bill for this service as "97110-GP" to denote the provider of the service.

How do I know which modifier to use?

The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).

What is the new test instead of a colonoscopy?

Overall, in addition to its 83% sensitivity for identifying colorectal cancers and 13% of advanced precancerous polyps found by colonoscopy, the Shield test had a specificity of 90%.

What is the biggest risk with a colonoscopy?

Risks
  • A reaction to the sedative used during the exam.
  • Bleeding from the site where a tissue sample (biopsy) was taken or a polyp or other abnormal tissue was removed.
  • A tear in the colon or rectum wall (perforation)

What not to eat before Cologuard?

The Cologuard test does not require any preparation. You do not need to change your diet or medicines before the test.

How fast do colon polyps come back after removing them?

During a mean of 2.5 ± 1.3 years of follow-up, 11 interval CRCs and 24 polyps with dysplasia were found. The proportions of polyp recurrence in 0.5 to 1 year, 1 to 2 years, 2 to 3 years, >3 years, and no recurrence after 3 years were 26.9%, 36.7%, 18.2%, 12.2%, and 6.0% respectively.

What foods should you avoid if you have polyps?

Foods to limit

Research suggests that eating less of the following foods may have health benefits and may lower your chances of developing polyps: fatty foods, such as fried foods. red meat, such as beef and pork. processed meat, such as bacon, sausage, hot dogs, and lunch meats.

What size polyp is worrisome?

Certain colon polyp features are more worrisome than others, but shape is not generally among them. The three things we tend to focus on most are: Size: Anything bigger than about 1 cm, or the width of a AAA battery. Number: The more pre-cancerous polyps someone has, the higher their risk will be.

Is colon screening covered by insurance?

Federal law

The Affordable Care Act (ACA) requires both private insurers and Medicare to cover the costs of colorectal cancer screening tests, because these tests are recommended by the United States Preventive Services Task Force (USPSTF).

Where does the camera go in a colonoscopy?

A colonoscopy is a procedure that lets your health care provider check the inside of your entire colon (large intestine). The procedure is done using a long, flexible tube called a colonoscope. The tube has a light and a tiny camera on one end. It is put in your rectum and moved into your colon.

Is a sigmoidoscopy cheaper than a colonoscopy?

Higher Cost: Colonoscopy screening typically involves higher costs compared to sigmoidoscopy due to its comprehensive nature and longer duration.