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Medicare G0431 - Medicare is denying G0431 stating

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    Medical Coding Books
    Which state are you in?

    Yulia Miller

  2. Default ? No duplicate rejections
    Did you received any rejection saying "duplicate" for using G0431-QW-59*4 twice. Kindly confirm

  3. Smile
    I think this is the only way we havent tried posting the units but will see if it works -
    Thanks for the suggestion

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    This has changed again? I can't find any official statements of this, but I am hearing that you can only bill one unit of G0431QW?? Has anyone else heard this. I was getting paid for the three lines last year, but now we are getting denials.

  5. #15
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by LuluBarr View Post
    This has changed again? I can't find any official statements of this, but I am hearing that you can only bill one unit of G0431QW?? Has anyone else heard this. I was getting paid for the three lines last year, but now we are getting denials.
    G0431 may only be reported once per patient encounter.

    Page 3

    http://www.cms.gov/MLNMattersArticle...ads/SE1105.pdf

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    Thank you!

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    UGH! Is modifier QW not used for medicare anymore?? I didn't know about the code change until I asked on here, so I went back and sent over 40 corrected claims for urine tests we have done in 2011. I sent G0434QW and they have ALL been denied for incomplete/incorrect/invalid modifier. What the heck is goin on!!

  8. #18
    Location
    North Carolina
    Posts
    3,126
    Default
    There was a recent update. Is it possible these denied prior to the update?

    Effective immediately, code G0434QW is added to the CLFS. Code G0434 can describe a CLIA waived test. The use of the QW modifier to indicate a CLIA waived test is necessary for accurate claims processing.

    http://www.cignagovernmentservices.c...cope14029.html

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    yes they were, so does that mean that I should remove the modifier for claims submitted before that update? Maybe I should just call them and explain maybe they can reprocess it.

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    So I called Medicare regarding these denied G0434QW claims and they said that CLIA waiver type 2 certificates will not get paid for this code. We can't bill for these CLIA waived tests with a CLIA certificate of waiver?? That doesn't make any sense. Does anyone have more information on this??

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