Nasal swabs; pronouncing death, modifier -QW; nursing home admissions
Answers to your questions about . . .
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Q: Should we bill insurance carriers for nasal swabs? We perform them in the office, but the lab does the interpretation.
A: Because the lab analyzes the nasopharyngeal swab test, you can't code for that, but you may bill for obtaining, handling, and conveying a specimen to a lab with 99000. That code also reflects the costs of preparing the specimen, such as centrifuging, separating serum, labeling tubes, packing for transport, filling out lab forms, and supplying necessary insurance information and documentation.
Medicare considers 99000 a bundled service and makes no separate payment for it. Some commercial payers, however, cover the service.
Q:I went to see a patient for a home visit only to find him dead. I did a brief physical exam to make the official determination and took a brief history from a family member. Can I charge for a regular home visit?
A: There's no code for "pronouncement of death," but you still provided a service and may bill for it, just as you'd bill for a discharge when a patient dies in the hospital.
The service provided probably won't meet the requirements for using the home services codes (99341-99350), though. It seems that the patient was established in the practice, so your service must include two of the three key components to use the home services codeshistory, exam, and medical decision-making. (If he were a new patient, you'd have to do all three.)
Your history-taking or medical decision-making was probably not of sufficient complexity to meet the code requirements. So your best choice is to code the visit using 99499 (unlisted E&M service). When using 99499, you should file a paper claim, include a cover letter explaining the service provided, and attach the medical record to the claim.
Q: When we perform waived lab tests, such as strep screens, should I use modifier QW?
A: Yes, you should report the procedure code appended with modifier QW. Clinical Laboratory Improvement Amendments (CLIA) groups lab tests into different categories, and when a test has a waived status, you may perform it without a higher-level certification. Modifier QW informs the payer that the test was done using an instrument that meets the CLIA-waived status. Make sure you put your CLIA number on the claim form.
Q:Can I bill for an office visit for an established patient and then bill for a nursing home admission the next day if I do the history and physical the next day? Or should it be bundled into the nursing home admission?
A: The answer hinges on the reason for the office visit. If you perform portions of the nursing home admission history and physical in the office on the day prior to the admission and complete the admission process on Day Two, then the office visit is bundled into the nursing home admission code (99303). But if the patient visited the office for management of an acute problem or a chronic illness, you can bill the office visit separately using the appropriate E&M code (99212-99215).
This information provided by The Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact The Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592; or visit www.codinginstitute.com.
Coding Consult: Answers to your questions about. . .. Medical Economics Jul. 25, 2003;80:20.