Pulmonology Coding Alert
Get CLIA Waiver, and You Can Bill for Simple Labs
Question: During a practice meeting last week, the subject of Clinical Laboratory Improvement Amendments (CLIA) waivers came up. We are currently not CLIA-waived, and we will discuss it again at next month's meeting. I was wondering if you could offer any input? Should we apply for a CLIA waiver? Nevada Subscriber Answer: Whether or not the waiver is worth it is up to the individual practice. However, the practice is not allowed to perform many basic laboratory services without CLIA-waived status. So if the practice does not get the waiver, it could be missing out on possible pay for some simple screens. Example: Here are a few of the tests that have CLIA-waived status: • 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 • 82270 --" Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection) • 81025 --" Urine pregnancy test, by visual color comparison methods. • 85651 --" Sedimentation rate, erythrocyte; non-automated. • 83026 --" Hemoglobin; by copper sulfate method, non-automated. • 82962 --" Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use. • 85013 --" Blood count; spun microhematocrit. If your pulmonary medicine practice has CLIA-waived status, you can perform (and code for) these tests and others. For your practice to perform CLIA-waived testing, Medicare requires that you: • enroll in the CLIA program by obtaining a certificate • pay the certificate fee every two years • follow the manufacturers' instructions for the waived tests • notify your state agency of any changes in ownership, nae, address or director within 30 days, or if you wish to add tests that are more complex • permit inspections by a CMS agent, such as a surveyor from the state agency. (Your laboratory is not subject to a routine survey or inspection.) For more info: Check out the application for the CLIA waiver at http://www.cms.hhs.gov/cmsforms/downloads/cms116.pdf. -- Answers to Reader Questions were provided and reviewed by Bruce Rappoport, MD, CPC, CHCC, a board-certified internist and medical director of Broward Health's Best Choice Plus and Total Claims Administration in Fort Lauderdale, Fla;, Robert B. Burleigh, CHBME, of Brandywine Healthcare Services in West Chester, Penn.; Kent J. Moore, manager of the Health Care Financing and Delivery Systems for the American Academy of Family Physicians; and Richard Tuck, MD, FAAP, with PrimeCare of Southeastern Ohio in Zanesville.
Pulmonology Coding Alert
- Zero In on These 2 Quality Measures to Earn Your CMS Bonus Check
You can even get credit for reporting that a patient did not meet criteria.All coding [...] - Prevent Shot, Hydration, IVIG Code Denials With This Guide
Overlooking Synagis treatment change will delay $21 per claimYou can save countless hours in appeals [...] - Never Assign E/M Codes Based on Length of Documentation
Instead, base your code choice on the documentation's content.Coding an E/M visit based on the [...] - Sleep Test or Polysomnography? Here's How to Tell the Difference
They may seem similar, but there's a big difference between your physician conducting a "sleep [...] - You Be the Coder:
Discern When to Code Presenting Symptoms
Question: An established patient reports to the pulmonologist complaining of trouble breathing and frequent coughing; [...] - Reader Questions:
What Are CMS's Proposed Guidelines for Non-Credentialed Physicians?
Question: I've heard how practices can hold a physician's claims while waiting for Medicare to [...] - Reader Questions:
Combat FluMist Denials by Following This Rule
Question: We have begun administering FluMist along with well checks and other immunizations. For the [...] - Reader Questions:
Get CLIA Waiver, and You Can Bill for Simple Labs
Question: During a practice meeting last week, the subject of Clinical Laboratory Improvement Amendments (CLIA) [...]
