Pathology/Lab Coding Alert

Don't forget CLIA certification info  Fiction: Choosing 83036 or 83037 for hemoglobin A1C depends on where you perform the test.
 
Fact: You can report 83037 regardless of location -- as long as you use a test that is Food and Drug Administration-approved for home use.
 
Why you should care: Home-approved 83037 pays $21.06 on the Clinical Laboratory Fee Schedule (CLFS) -- compared to $13.56 for 83036. -Home-Approved- Doesn't Mean -Home-Required-  You may find the 83037 code descriptor confusing: Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use. But the -home use- part just means that you need to make sure your lab uses one of the devices the Food and Drug Administration (FDA) approved for use at home before reporting 83037, experts say.
 
Part B carrier Noridian Medicare put out a coverage notice saying you can bill either A1C test code 83036 (Hemoglobin; glycosylated [A1C]) or 83037 in a physician-office lab. The main difference is that 83037 describes -devices cleared by the FDA for home use.- So you should be careful not to use 83037 if your lab uses a -desk-top analyzer- or other device that the FDA hasn't approved for use at home, Noridian says.
 
Good news: In 2006, more than half of Medicare carriers paid only $13.56 for 83037, but in 2007 the code reimburses about $21.06 nationwide.

Choose the Right Code  Many physicians want A1C test results available during the patient visit. That's why they might offer point-of-care testing using the FDA-approved device. You should report these tests as 83037.
 
Otherwise, the lab often receives a request for the test a few days before the physician visit and reports 83036 for the standard A1C lab test, usually determined by ion-exchange affinity chromatography, immunoassay, or agar gel electrophoresis. Then the physician may counsel the patient about the test results at the visit. Don't Forget CLIA  Despite the home-use terminology, Medicare won't cover patient self-testing for A1C, Noridian adds. Medicare will cover the test from only providers or laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA).
 
Important: You should append modifier QW (CLIA waived test) to 83037 and make sure your lab has its own CLIA certificate before using this code, says Marie West with Medical Data Services in Edmund, Okla. You should refer to the most current CLIA waived test list to make sure your particular test kit is OK to bill using this code, she adds. You can find the most current list on the Internet at www.cms.hhs.gov/transmittals/downloads/
R1197CP.pdf.
 
The list now includes the following tests reportable to 83037-QW:

 - Bio-Rad Micromat II Hemoglobin A1c Prescription Home Use Test (manufacturer, Bio-Rad Laboratories)
 
- Cholestech GDX A1C Test (Prescription Home Use) (manufacturer, Cholestech Corporation)
 
- Metrika A1c Now [...]