February 26, 2015
Denials of claims for anesthesia for screening endoscopy that becomes diagnostic (Code 00810 with modifier PT)
We have received reports that claims for anesthesia for a screening endoscopy that becomes diagnostic in nature and reported via CPT® code 00810 with modifier PT per the instructions in the CY2015 Final Rule on the Medicare Physician Fee Schedule are being denied with stated reason that the CPT code is inconsistent with the modifier. ASA has discussed this situation with CMS staff who have informed us that they are aware of this problem and working on best way to address it. ASA will stay in touch with CMS and post information to our website as it becomes available.