CLIA Billing Details

Question: I enjoy your newsletter on coding and the article on CLIA was very informative until I got to the last statement. It said that we learn from the mistakes we make. Well, I certainly learned from mine: I added the –QW modifier to a lab test that was CLIA-waived but did not have the –QW listed on the CLIA list. If you double-check the CLIA list, some CPT codes have –QW and some do not. Those that do not have the –QW do not require it when filing. We received denials for invalid modifier and I was required to remove the –QW to those codes I had previously added. I thought that if a lab test was waived it required the –QW.

Answer: Answer provided by Betsy Nicoletti, certified professional coder:

That’s right, generally, but there is a qualification. Many tests, such as measuring a patient’s glucose, have many ways to perform them: quantitative, qualitative, via an assay, via a culture, or via a test kit that changes colors. Tests that may be performed via a test kit (not requiring a lab tech’s clinical skill) can be done in the office and are placed on the CLIA-waived list. It is important to check the list and make sure that the exact test for glucose that you are performing is on the list, and that you are using the correct CPT code for that test. You don’t want to use the code for strep test done by culture without the -QW modifier (and get paid for that service) when you have performed the quick strep test done by kit (87880), which is on the CLIA-waived list.