Pathology/Lab Coding Alert

Question: Our lab operates under a CLIA certificate of waiver. Do we need to use modifier QW on all lab tests?

Louisiana Subscriber

Answer: You need HCPCS level-II modifier QW (CLIA waived test) on tests that qualify as both waived (simple) and nonwaived (moderately or highly complex).

When a test is eligible for waived status only, you do not need a modifier to denote that you are performing a waived test. Common waived tests that do not require modifier QW, per CMS, include the following:

- 81002 --" Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy

- 81025 --" Urine pregnancy test, by visual color comparison methods

- 82270 and 82272 --" Blood, occult, by peroxidase activity (e.g., guaiac), qualitative

- 82962 --" Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use

- 83026 --" Hemoglobin; by copper sulfate method, non-automated

- 85013 --" Blood count; spun microhematocrit

- 85651 --" Sedimentation rate, erythrocyte; non-automated.

But when a test falls under both waived and nonwaived status, you should use modifier QW to indicate you are performing the test's waived version. Without the modifier, the carrier might deny the claim, thinking that your CLIA-waived lab is trying to bill for a moderate-complexity test.

For example: Two CLIA-waived tests that require QW include tests for influenza and strep. When reporting waived versions of these tests to insurers that use QW, you should enter QW in the modifier field after the test code, for instance 87804-QW (Infectious agent antigen detection by immunoassay with direct optical observation; influenza).

To check if you-re using a test's waived version, look for the test name on the -List of Waived Tests- available on the internet at www.cms.hhs.gov/CLIA/10_Categorization_of_Tests.asp#TopOfPage.

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.