ADDITION OF QW MODIFIER TO HCPCS CODE 87426

CPT recently added one new Category I code (87426) to provide increased specificity for reporting immunoassay antigen testing and two new proprietary laboratory analyses (PLA) testing codes (0223U, 0224U) to its official website on June 25, 2020. These codes are in current use to report the laboratory tests.

This article informs you about the new update of adding QW modifier to HCPCS code 87426.

Update on Modifier QW:

Modifier QW is used to indicate that the diagnostic lab service is a CLIA (Clinical Laboratory Improvement Amendment) waived test and that the provider holds at least a Certificate of Waiver. The provider must be a certificate holder in order to legally perform clinical laboratory testing.

MLN Matters article 11927, released on July 24, 2020, notifies the addition of modifier -QW with HCPCS code 87426 for antigen diagnostic testing for SARS-CoV-2. Because the test is authorized for use at the point of care under the Emergency Use Authorization (EUA), facilities with a valid CLIA certificate of waiver should report the code with modifier -QW.

HCPCS code 87426:

Description: Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19]).

Code 87426 is to be reported for the infectious agent antigen detection by immunoassay technique of SARS-CoV and SARS-CoV-2, and it will be a child code under parent code 87301. This new code allows for more precise reporting of immunoassay testing for SARS-Coronovirus antigen. It should be also noted that this code is not specific for SARS-CoV-2, and it could be used for an immunoassay that detects antigenic proteins for either SARS-CoV or SARS-CoV-2.

Here is a succinct overview of SARS-CoV-2 related CPT codes published in the recent times:

Code 87635: Effective March 13, 2020

Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

Code 86318: Effective April 10, 2020

It is revised to report immunoassay for infectious agent antibodies and be a parent code to 86328.

Code 86328: Effective April 10, 2020

It is used to report Immunoassay for infectious agent antibody (ies), qualitative or semi quantitative, single-step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Code 86769: Effective April 10, 2020

It is used to report an antibody test for SARS-CoV-2 using a multiple-step method.

PLA code 0202U: Effective May 20, 2020

It is used to report the BioFire Respiratory Panel 2.1 (RP2.1) test.

Code 87426: Effective June 25, 2020

It is used to report Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2)

PLA Codes 0223U and 0224U Effective June 25, 2020

These two new proprietary laboratory analyses codes which are specific to the manufacturer are used for the detection of SARS-CoV-2.

0223U: QIAstat-Dx Respiratory SARS-CoV-2 Panel, QIAGEN Sciences, QIAGEN GMbH

0224U: OVID-19 Antibody Test, Mt Sinai, Mount Sinai Laboratory

Happy learning! Happy coding!


Resources:


3 Comments

Leave a Reply