Pediatric Coding Alert

Pediatricians perform many "lab" tests in the office such as rapid tests to denote whether the patient has strep throat, influenza or mononucleosis. Because of technological advances resulting in a proliferation of new tests and some new codes, pediatricians may not know which code to use. Below are common "waived" tests in-office tests that under the Clinical Laboratory Improvement Act (CLIA) may be performed without a high-level certification and their correct codes.
 
Waived status: Consider your CLIA status when selecting a test code: If, like most pediatricians, you have only waived status, do not use any code that requires a higher-level certification. Some physicians may want to use a test that is clinically appealing, and therefore the practice opts to have a moderate-complexity certification, which requires a big financial investment, explains Joan Gilhooly, CPC, CHCC, a coding and reimbursement consultant based in Deer Park, Ill. "But most pediatric groups have waived status," she says. When filing with Medicare, use modifier -QW (CLIA waived test) to indicate that a test is waived.
 
Note: We do not endorse any of the tests referenced in this article, but cite them for identification purposes for our readers' convenience.
Common Tests
Urinalysis: For urine screening for a variety of conditions, including diabetes, urinary tract infections, dehydration and jaundice, use 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). Bill 81003 ( automated, without microscopy) for the Bayer Clinitek 50 Urine Chemistry Analyzer, the Chemstrip Mini UA from Boehringer Mannheim, the Roche Diagnostics/Boehringer Mannheim Chemstrip 101 Urine Analyzer, Teco Diagnostics URITEK TC-101 Urine Strip Reader. Use CPT 81007 (Urinalysis; bacteriuria screen, except by culture or dipstick) for the Diatech Diagnostics Uri screen that is approved for OTC use and detects catalase that is associated with urinary tract infections. There are two codes for the Bayer Multistick Pro reagent strips: 81002 and 82570 (Creatinine; other source). These two Bayer test systems have been added recently to the list of waived tests.
 
Rapid strep test: Use 87880 (Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A) for the tests that rapidly test group A streptococcal antigen from throat swabs: the Abbott Signify Strep A Test, the Applied Biotech SureStep Strep A (II), Beckman Coulter Primary Care Diagnostics ICON FX Strep A Immunochemical Strep A Test, Becton Dickinson LINK 2 Strep A Rapid Test, Binax NOW Strep A Test, BioStar Acceava Step A Test, Genzyme Contrast Strep A, Fisher HealthCare Sure-Vue Strep A, Jant Pharmacal AccuStrip Strep A (II), LifeSign LLC Status Strep A, Mainline Confirms Strep A Dots Test, Meridian Diagnostics ImmunoCard STAT Strep A from Applied [...]