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Thread: QW modifier

  1. #1
    Join Date
    Apr 2007
    Location
    York, Pa
    Posts
    1,901

    Default QW modifier

    Hello all,

    I am at a new employer now and I am unsure as to why they are using the QW modifier for Medicare claims when they bill a cpt code in the 80000 series, where I used to work we billed for those codes and we never had to use this QW modifier, when I asked why we are using it and what it means because I have never heard of it. I am being told because they were told to, no one knows why but they just do.

    I just want to get some clarification on this, since I have no prior experience with it.

    I think I will also check my local medicare carrier website to see if I can get a clue.

    TIA
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  2. #2
    Join Date
    Apr 2007
    Location
    York, Pa
    Posts
    1,901

    Default

    Ok, so I checked Medicare's website and I now know that QW= clia waived test, but I am still unclear, I don't mean to sound stupid but the office I came from this wasn't an issue, and at this point no one can tell me why we have to use it... I'm just looking to get some clarification....

    Any help will be appreciated.





    Quote Originally Posted by rthames052006 View Post
    Hello all,

    I am at a new employer now and I am unsure as to why they are using the QW modifier for Medicare claims when they bill a cpt code in the 80000 series, where I used to work we billed for those codes and we never had to use this QW modifier, when I asked why we are using it and what it means because I have never heard of it. I am being told because they were told to, no one knows why but they just do.

    I just want to get some clarification on this, since I have no prior experience with it.

    I think I will also check my local medicare carrier website to see if I can get a clue.

    TIA
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. #3

    Default

    We put the QW on some of our 80000 codes that we do in house. We have always wondered if they are suppose to go on all as well and have always been told what you are being told. So I went to look it up and go to the following link and I think this may help. Starting on the 5th page it gives you a list of the codes that require the QW.

    Jessica Harrell, CPC

  4. #4
    Join Date
    Apr 2007
    Location
    San Diego
    Posts
    163

    Default

    Hi,

    CLIA stands for "clinical laboratory improvement amendments". It is a law that establishes quality standards for all laboratory testing (except research) to ensure the accuracy, reliability and timeliness of patient tests. There are all sorts of guidelines & criteria that a "laboratory" must meet. As per CLIA, the definition of a "laboratory" is as follows: "a facility that performs testing on materials derived from the human body for the purpose of providing information for the diagnosis, preventionm, or treatment of any disease or impairment of, or assessment of the health of, human beings."

    There are different levels of certificates that are required in order for a facility to do lab tests. The QW modifier states that the tests you are performing are "simple laboratory examinations and procedures that have an insignificant risk of an erroneous result". They are considered "CLIA waived" and therefore require a "CLIA Certificate of Waiver". You can access a complete list of the CLIA waived tests via the link I've included below.

    This in a nutshell, I think answers some of your questions. There is more in-depth information that you can find on the CLIA webiste. I've included the link for you below:

    http://www.cms.hhs.gov/CLIA/01_Overview.asp#TopOfPage

    Hope this helps & Good Luck.
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  5. #5

    Default

    http://www.cms.hhs.gov/transmittals/...ads/R325CP.pdf

    Sorry here is the link I was talking about

  6. #6
    Join Date
    Apr 2007
    Location
    York, Pa
    Posts
    1,901

    Default

    thompsonsyl,

    Thank you very much for the info... I appreciate your prompt, clear response, it all makes sense now.

    Again thanks



    Quote Originally Posted by thompsonsyl View Post
    Hi,

    CLIA stands for "clinical laboratory improvement amendments". It is a law that establishes quality standards for all laboratory testing (except research) to ensure the accuracy, reliability and timeliness of patient tests. There are all sorts of guidelines & criteria that a "laboratory" must meet. As per CLIA, the definition of a "laboratory" is as follows: "a facility that performs testing on materials derived from the human body for the purpose of providing information for the diagnosis, preventionm, or treatment of any disease or impairment of, or assessment of the health of, human beings."

    There are different levels of certificates that are required in order for a facility to do lab tests. The QW modifier states that the tests you are performing are "simple laboratory examinations and procedures that have an insignificant risk of an erroneous result". They are considered "CLIA waived" and therefore require a "CLIA Certificate of Waiver". You can access a complete list of the CLIA waived tests via the link I've included below.

    This in a nutshell, I think answers some of your questions. There is more in-depth information that you can find on the CLIA webiste. I've included the link for you below:

    http://www.cms.hhs.gov/CLIA/01_Overview.asp#TopOfPage

    Hope this helps & Good Luck.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  7. #7

    Default Office manager

    I need to know do we use qw modifire for lab test only for medicare patient.

  8. #8
    Join Date
    Apr 2007
    Location
    Tucson Arizona Chapter
    Posts
    2

    Default

    Quote Originally Posted by taham View Post
    I need to know do we use qw modifire for lab test only for medicare patient.
    You may use the QW modifier for patients with private insurance. I work for a billing office that specializes in treatment facilities, and the QW modifier can be used for ANY CLIA-certified test that is performed, regardless of the patient's insurance.

  9. #9
    Join Date
    Apr 2007
    Location
    Tucson Arizona Chapter
    Posts
    2

    Default

    Quote Originally Posted by thompsonsyl View Post
    Hi,

    CLIA stands for "clinical laboratory improvement amendments". It is a law that establishes quality standards for all laboratory testing (except research) to ensure the accuracy, reliability and timeliness of patient tests. There are all sorts of guidelines & criteria that a "laboratory" must meet. As per CLIA, the definition of a "laboratory" is as follows: "a facility that performs testing on materials derived from the human body for the purpose of providing information for the diagnosis, preventionm, or treatment of any disease or impairment of, or assessment of the health of, human beings."

    There are different levels of certificates that are required in order for a facility to do lab tests. The QW modifier states that the tests you are performing are "simple laboratory examinations and procedures that have an insignificant risk of an erroneous result". They are considered "CLIA waived" and therefore require a "CLIA Certificate of Waiver". You can access a complete list of the CLIA waived tests via the link I've included below.

    This in a nutshell, I think answers some of your questions. There is more in-depth information that you can find on the CLIA webiste. I've included the link for you below:

    http://www.cms.hhs.gov/CLIA/01_Overview.asp#TopOfPage

    Hope this helps & Good Luck.
    This is a well-worded, brilliant answer. Thank you for taking the time to make it. It has cleared a few of my doubts about CLIA. Thanks again. :)

  10. #10
    Join Date
    Apr 2007
    Location
    Coastal Coders
    Posts
    411

    Default

    Hi Roxanne

    Here is a link to the CMS pdf I use:

    http://www.cms.gov/Regulations-and-G...s/waivetbl.pdf


    Save it to your desktop and search it using the "find" feature.
    Hope this Helps
    Pete

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