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Update for COVID -19 CPT 87637

The Modifier QW is defined as a Clinical Laboratory Improvement Amendment (CLIA) waived test and it is used to identify waived tests and would be submitted in the first modifier field. The modifier QW is accepted by CMS for CPT 87637 and effective from date October 06,2020 and the implementation date July 06, 2021. Also, the modifier QW allowed for HCPCS code 0240U & 0241U 87637 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique 0240U - Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected 0241U - Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targe

Additional Information About Modifiers

Sequencing of modifiers  How can that be if the modifiers used were accurate?  There is an order to reporting modifiers and there are three categories that modifier usage fall under:  1. Pricing  Pricing modifiers are always sequenced “before” payment modifiers and/or location modifiers.   The only exception to this rule is when a global surgery package is involved.  For example, you would code modifier 58 first and modifier 82 second in a global surgery.  A few examples of pricing modifiers are: 22, 26, 50, 52, 53, 62, 80, and P1-P6.   2. Payment   Payment modifiers alert the insurance carrier that there is a special situation within the claim  Some examples of payment modifiers would be: 24, 25, 51, 57, 58, 59, 76, and 78.  3. Location  Examples of location modifiers are: E1-E4, FA, F1-F9, LC, LD, LT, RT, RC, TA, and T1-T9.  The general order of sequencing modifiers is ( 1) pricing (2) payment (3) location. Location modifiers, in all coding situations, are coded “last”.  If you code

Modifier 78 and 79

Modifier 78  “Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the post-operative period  Modifier 79 “Unrelated procedure or service by the same physician during a post-operative  Example - Modifier 78  The Dual chamber Pacemaker (CPT 33208) was implanted on Dec 26th and during the post-operative periods, the patients feel uncomfortable due to pain, hence the provider examined and confirmed the Atrial lead and or Ventricular lead is dislodged, hence provider performed “Repositioning of right atrial or right ventricular lead” on Jan 10th.   For mentioned above scenarios, the claim must be submitted with modifier 78, since this procedure performed within 90 days. CPT 33215 – 78  Example - Modifier 79  The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.   Provider performs right toe amputation on May 24,

Usage of Modifier 24 and 59

Modifier 24  An Unrelated evaluation and management service performed by the same physician or other qualified health care professional during a post-operative period use modifier 24 for E/M Services. (Never to a procedure)  Modifier 24 is applied to two code sets,  E/M (Evaluation and management) services (99201-99499).  General ophthalmological services (92002-92014), which are eye examination codes.  Appropriate Use of Modifier 24  An unrelated E/M service is performed beginning the day after the procedure, by the same physician, during the 10 or 90-day post-operative period.   Documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care. Unrelated critical care performed by the same physician during the post-operative period.  Inappropriate Use  Do not use Modifier 24 when,  The E/M is for a surgical complication or infection. This treatment is part of the surgery package.  The service is removal  of sutures or othe

Usage of Modifier 25 vs 57

 Modifier 25  Significant, separately identifiable evaluation and management [E/M] service by the same physician or Other Qualified Health Care Professional on the same day of the service  Modifier 25 is appended to an E&M service, when performed 0 days and or 10 days global period - (never to a procedure)  Example 1:   A patient visits the cardiologist for an appointment complaining of occasional chest discomfort during exercise. The patient has a history of hypertension and high cholesterol. After the physician completes an office visit it is determined that the patient needs a cardiovascular stress test that is performed on same day by the same physician.  The physician codes an E/M visit (99201 – 99215) and he also codes for the cardiovascular stress test (93015). The modifier 25 is added to the E/M visit to indicate that there was a separately identifiable E/M on the same day of a procedure.  The modifier stops the bundling of the E/M visit into the procedure. When reviewing