Wiki Urgent Care Help!

[AngelaMehl]

I have recently taken on the coding for an Urgent Care clinic outside of my regular Family Practice.

My main question is this: Do I append the -26 on the x rays? We own the equipment and the physician reads the x ray.

Secondly: Do I need to append -QW on ALL labs as it seems this modifier does not work on a UA dipstick (81002) or for the venipuncture (36415).

Any help you can give me will be much appreciated. This is a new urgent care practice and we are having a very difficult time getting reimbursed.

If you can guide me to some great information on urgent care billing, that would be very much appreciated as well!

Thank you!
Angela Mehl, CPC

 

[ALWebster19]

response

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/MM9416.pdf

The Current Procedural Terminology (CPT) codes for these new tests in Table 1 must have the modifier 'QW' to be recognized as a waived test. However, the tests referenced in the attachment of CR9416 titled, “TESTS GRANTED WAIVED STATUS UNDER CLIA”, do not require a 'QW' modifier to be recognized as a waived test
81002 and 81003 are Clia Waived tests.

https://www.cms.gov/Outreach-and-Ed...s/downloads/Radiology_FactSheet_ICN907164.pdf

You would use Mod 26 only if the Doctor was at a hospital or other location where they have privledges and they are reading an X Ray. They do not own the machine and it is not their facility, so they are only providing the "professional" portion by reading the X ray
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