How do I bill CPT 87804?
If the provider documents that the test provides two separate results — one for influenza virus A and one for B — it would be appropriate to report two units of code 87804, says Witt. Mac advises coders to list 87804 on two lines with modifier 59 Distinct procedural service appended to the second unit of 87804.
Does 87804 need a QW modifier?
Code 87804 describes the rapid flu test approved by the FDA requiring Clinical Laboratory Improvement Act (CLIA)-waived status. Use this code for detection by visual identification. Reporting tip: Many Medicaid states require you to follow Medicare modifier guidelines and append modifier QW (CLIA-waived test) to 87804.
Can CPT code 87804 be billed twice?
For example, CPT 87804 is billed twice if both an in- fluenza A and B test are ordered. This would be counted as only one order.
How do you bill for rapid flu test A and B?
The CPT® code modifier 59 is used to identify a distinct procedural service. In the context of influenza immunoassay testing, it supports coding CPT® 87400 once for influenza type A and once for influenza type B.
What modifier do I use for 87804?
87804 describes the rapid flu test approved by the FDA requiring Clinical Laboratory Improvement Act (CLIA)-waived status. Use this code for detection by visual identification. Reporting tip: Many Medicaid states need you to follow Medicare modifier guidelines and add modifier QW (CLIA-waived test) to 87804.
When should the QW modifier be used?
Modifier QW is used to indicate that the diagnostic lab service is a Clinical Laboratory Improvement Amendment (CLIA) waived test and that the provider holds at least a Certificate of Waiver. The provider must be a certificate holder in order to legally perform clinical laboratory testing.
When should modifier QW be used?
When would you use modifier 59?
Modifier 59 should be used to distinguish a different session or patient encounter, or a different procedure or surgery, or a different anatomical site, or a separate injury. It should also be used when an intravenous (IV) protocol calls for two separate IV sites.
What is QW modifier medical coding?
Use QW modifier to the Lab/Pathology services that are on the CLIA waived test list provided by the CMS. QW modifier is only for 8xxxx series codes found in CPT book. CLIA requires a facility to be appropriately certified for each test it performs.
What CPT codes are CLIA waived?
The CLIA-waived procedures that do not require HCPCS modifier QW include: CPT codes 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013 and 85651, and HCPCS code G0394.
Which modifier goes first 26 or 59?
Always add 26 before any other modifier. If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position.
Can you bill modifier 50 and 59 together?
As long as the coding submitted supports separate payment, there should be no issues. If only one procedure was performed bilaterally, modifier -59 should not be used on the charge with modifier -50.
What CPT codes are CLIA-waived?
What are 3 examples of CLIA waived tests?
3. What is waived testing? By the CLIA law, waived tests are those tests that are determined by CDC or FDA to be so simple that there is little risk of error. Some testing methods for glucose and cholesterol are waived along with pregnancy tests, fecal occult blood tests, some urine tests, etc.
What are 4 examples of CLIA waived tests?
The specific tests that are deemed to be CLIA waived are:
- Non-automated urinalysis using dipstick or tablet reagents.
- Ovulation tests.
- Urine pregnancy tests.
- Fecal occult blood.
- Hemoglobin-copper sulfate.
- Erythrocyte sedimentation rate.
- Blood glucose monitoring utilizing devices specifically for home use.
- Spun microhematocrit.
When should modifier 59 be used?
When should modifier 26 be used?
Modifier 26 is defined as the professional component (PC). The PC is outlined as a physician’s service, which may include technician supervision, interpretation of results and a written report. Use modifier 26 when a physician interprets but does not perform the test.
What is the difference between CLIA and CLIA waived?
Waived tests include test systems cleared by the FDA for home use and those tests approved for waiver under the CLIA criteria. Although CLIA requires that waived tests must be simple and have a low risk for erroneous results, this does not mean that waived tests are completely error-proof.
Which modifier comes first 26 or 59?
What is the difference between modifier 25 and 26?
25 Significant, separately identifiable evaluation and management (E/M) services by the same physician on the same day of the procedure or other service. 26 Professional Component refers to certain procedures that are a combination of a physician component and a technical component.
What are the 3 types of CLIA waivers?
CLIA regulatory requirements classify testing into three categories: high complexity, moderate complexity and waived.