Pediatric Coding Alert

Question: Our practice recently got its Clinical Laboratory Improvement Amendments (CLIA) waiver, and I just received my first claim with a CLIA-waived test. How do I submit my CLIA-certified claim for a flu test by immunoassay with direct observation?

Missouri Subscriber

Answer: Once your practice has a CLIA waiver, it’s allowed to perform several tests that labs typically perform — including influenza virus scans by immunoassay. On the claim, you should report 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; Influenza) for the screening.

Modifier alert: For your CLIA-waived claim to fly, you might need to attach modifier QW (CLIA-waived test) to 87804 to show that you have a CLIA waiver. The QW modifiers identifies a CLIA-waived test, and informs the payer that your practice has CLIA-waived status and is allowed to report the test. However, many carriers have no problem with CLIA-waived claims that lack modifier QW, as most CLIA waived tests are well known. The QW modifier is used all the time for Medicare claims, however.

The list of waived tests that CLIA-waived practices can perform is available at: at www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/waivetbl.pdf.