Wiki ABN & QW modifiers

[Thouvenel]

I just started work in a family practice clinic and noticed they are having Medicare pts sign ABN for PT/INR, but are using the QW modifier for CLIA waived testing with the dx of HX of DVT and long term use of anti coag.....can someone please tell me if this is correct? It seems like overkill to have them sign the waiver if Medicare covers it under this DX.

 

[mitchellde]

It is not correct. If you are having a patient sign an ABN for a covered service then you must append a GA modifier to the CPT/HCPC code the ABN was obtained for. You should never have an ABN for covered services, but if one is signed then the modifer must be used, Mcare will probably then deny the service and make it patient responsibility. The correct code for a PT INR for a patient on anticoag with a hx of DVT is V58.83 first, then V58.61, then V code for HX of DVT.

 

[Thouvenel]

Ok, so if the ABN is signed, it needs to be put on the claim. Is PT INR clia waived? Isn't the PT INR payable by medicare without the ABN? I just need a clear cut picture to take with me to the staff so I can override the previous way of doing things, and it benefits we as well to understand. Thank you for your help.

 

[mitchellde]

A PT/INR is payable by Medicare within certain parameters, meaning timing and diagnosis. I do not remember if a QW is required but I think so. When in doubt go find the LCD/NCD for PT/INR it will tell you what you need to know for your region.