Oncology & Hematology Coding Alert

Question: We're a CLIA-waived lab performing the NMP22 test by Alere. How should we report the test?

Tennessee Subscriber

Answer: The CPT® 2012 code for nuclear matrix protein 22 (NMP22) is 86386 (Nuclear Matrix Protein 22 [NMP22], qualitative), but that's not the entire answer to your question.

Because you're a lab operating with waived status under the Clinical Laboratory Improvement Amendments (CLIA), you can perform and report only those tests that are granted waived status. When you report a waived test, you need to append modifier QW (CLIA waived test) to the lab test code.

You'll find that the CLIA-waived test list, effective April 1, 2012, does include 86386-QW. The effective date of the waived status for the code is Jan. 1, 2012. You can see the list at www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/waivetbl.pdf.

The test: As the CLIA-waived test list states, the test is an Immunoassay for the qualitative detection of nuclear matrix protein NMP22 in urine for use as an aid in monitoring bladder cancer patients.