CODING & DOCUMENTATION
Fam Pract Manag. 2020 Jul-Aug;27(4):36.
Author disclosure: no relevant financial affiliations disclosed.
- LAB TESTS REQUIRING MODIFIER QW
- NEWBORN: NEW PATIENT OR NOT?
- SHARED SERVICES FOR NEW PATIENTS
- CODING SEX-SPECIFIC SERVICES FOR TRANSGENDER PATIENTS
- PACEMAKER DUE TO SICK SINUS SYNDROME
LAB TESTS REQUIRING MODIFIER QW
How do I know which laboratory tests require modifier QW?
Medicare uses modifier QW to indicate that a test is CLIA-waived and the reporting physician's practice has a CLIA certificate that allows the physician to perform and report CLIA-waived tests. You can verify that a test is CLIA-waived at https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/Downloads/waivetbl.pdf. Certain codes describe only CLIA-waived tests and therefore are exempt from the requirement to add the QW modifier. The CPT codes for the tests currently exempt from the requirement are 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651.
NEWBORN: NEW PATIENT OR NOT?
If a hospitalist in my group practice provided hospital care to a newborn, is the patient new to me when I provide the first well-child visit?
It depends on your and your colleague's specialties. Let's assume you are a family physician. The newborn is new to you only if no other family physician in your group practice has provided a face-to-face service to the newborn prior to your service. CPT states that a new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty in the same group practice, within the past three years. However, some plans do not recognize subspecialties for purposes of defining a new patient service. If the physician who previously provided care to the patient was a family physician with a subspecialty (e.g., a hospitalist), your staff should review your health plans' reimbursement policies to determine whether they use the CPT standard or their own definition of new patient.
SHARED SERVICES FOR NEW PATIENTS
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