Kelly Posted Wed 24th of October, 2012 15:00:43 PM
Our physician orders a Hemoglobin to be done by fingerstick using our Hemocue machine. Can we bill a '85018' and '36416' for this service? A medical assistant would be doing the fingerstick on the patient and operating the machine. Is '85018' considered a clia waived test and would we need to append the QW modifier? We are mostly doing this on Medicare Part B, Pennsylvania patients. Thank you.
SuperCoder Answered Thu 25th of October, 2012 11:59:55 AM
Yes, you can submit 36416 (Collection of capillary blood specimen [eg, finger, heel, ear stick]) with 85018 (Blood count; hemoglobin [Hgb]). Some payers, such as Medicare, will not pay for 36416 because they consider it a "bundled" service. Check the guidelines for the payer in question to be sure you file correctly and to know what to expect from reimbursement.
Yes absolutely its a QW modifier to be appended to this CLIA waved test.
CMS requires labs operating with a certificate of waiver to report approved tests with modifier QW (CLIA-waived test).