Medical Coding Tips — Modifier QW CLIA Waived Modifier

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• published: 16 Jul 2015
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Medical Coding Tips — Modifier QW CLIA Waived Modifier http://www.cco.us/ceu-on-demand-classes-modifiers-yt JoAnne: Oh, yes, this one. A: Last month, I gave us a coding scenario and I had a level 3 office visit, no modifier, and the patient had a rapid strep test and I added the modifier QW to the rapid strep test which was 87880. A lot of people wrote in and said, “What the heck is QW and how do you know when to use it,” and it was very confusing. Even though you study that for the CPC exam, unless you work with it every day, it’s just something that is not that important to you, but it is [0:32:53 - rarely] important. CLIA means Clinical Laboratory Improvement Amendments, and most medical practices, they apply and pay for CLIA waived certificates. They are given a number that indicates that they have a CLIA waived certificate. The rapid strep test, for example, is a CLIA waived exam and if you bill it without that QW, you are not going to get paid. But, the thing is, is that, there are HCPCS codes and there are CPT codes, and the CLIA waived certificate is for the doctor’s office who does basic urinalysis, urine pregnancy test, stool guaiacs, the simple glucose - the blood sugar test. Things like that, nothing extensive. But, what you really need to do if you’re a manager or if you have anything to do with the coding and billing is that you have to go on to the website, CMS.gov website, and save on your desktop the list of the CLIA waived lab tests that the physicians can bill for. They are constantly updated and there are a ton of different manufacturers. What I highly recommend is that if a doctor is doing a test or even if they’re ordering medicine, or anything, get the invoice from the manufacturer so you know the dosage, you know the type of test, you know everything, and how much it cost the physician. So, that’s very important. The other thing to keep in mind with the CLIA waived certificate and the modifier-QW is that the CLIA number is linked to the office location. If a doctor has two offices that he practices in, he needs two separate CLIA waived certificates and he needs them linked separately to each location. That’s also very important. Get more medical coding training, medical coding tips, medical coding certification and free medical coding webinars at http://www.cco.us/cco-yt