Revenue Cycle Insider

Question: I work for an outpatient office where providers regularly perform and interpret in-house testing for patients with suspected bacterial vaginosis. I usually code 87210 for the procedure they use, but is modifier QW ever appropriate?

California Subscriber

Answer: There isn’t enough information here to fully answer your question, as the decision to append modifier QW (CLIA-waived test) may depend on the patient’s respective payer, the practice’s Clinical Laboratory Improvement Amendments (CLIA) certification status, and current billing and CLIA categorization requirements.

Generally, when an outpatient provider performs and interprets a wet mount to evaluate suspected bacterial vaginosis, CPT^® code 87210 (Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps)) may be appropriate when documentation supports that a wet mount was prepared, microscopically examined, and interpreted by the provider or qualified laboratory personnel. Documentation should also clearly identify the specimen source and the findings reported (for example, clue cells, yeast, or trichomonads).

Because CLIA-waived status is determined by applicable CLIA guidance and test categorization rather than the CPT^® code descriptor alone, you should verify current respective payer requirements before reporting code 87210 with or without modifier QW.

You can find more information regarding CLIA waiver testing in the Medicare Claims Processing Manual, Chapter 16, 70.8 and the current categorization of specific tests in the Food and Drug Administration (FDA) CLIA database.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC