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Family Practice Coding Alert

Reader Questions:

Not All Payers Require Modifier -QW

Question: The January Family Practice Coding Alert article "Avoid Lab Code Denials With In-Depth Waived-Status Info" states that I should use modifier -QW on all CLIA-waived tests. But when I report in-office urinary test analysis with 81002-QW, payers deny my claims. I receive payment with 81002.

Colorado Subscriber  Answer: Medicare does require you to append modifier -QW (CLIA-waived test) to all Clinical Laboratory Improvement Amendments waived-status test codes, such as 81002 (Urinalysis, by dipstick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy). Remember that modifier -QW is a Medicare modifier.
Local private payers may have different rules. Check with your representatives on their CLIA-waived test reporting requirements. Try, if possible, to obtain their regulations in writing to ensure coding compliance.

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