Monday, August 26, 2013

Wet Prep and Fern Testing in OB-GYN

Good Morning - I had a query last week regarding the criteria necessary for billing for these two tests in an OB/Gyn and OB Hospitalist office. Here's what you need to know: The FERN test: Provided the physician documents that THEY did the procurement (not a nurse or medical assistant) and personally reviewed the slide, and notated the medical record as such. The physician can then bill a HCPCS code Q0114 with dx's such as 658.13 (Premature Rupture of Membranes PROM), 646.83 (Oth antepartum complication) KOH Wet prep: Again the physician must document and be the one who procures the KOH Wetmount HCPCS Code Q0112 can be billed. This code will pass a CCI edit scrub with dx's such as 658.13 (PROM), 646.83 (Oth Antepartum complication) 623.5 Leukorrhea. It did not pass edit check for code 616.10 (Bacterial Vaginosis). Wet mounts, including preparations of vaginal, cervical or skin specimens HCPCS Code Q0111 can be billed and it passes the edits with the same dx's as above (see KOH Wet Prep) . Actual reimbursement for these would depend on the insurance carrier, or 3rd party payers, and their particular edit scrubs and/or contracts with providers. However, at this time these HCPCS codes are the valid way to code for these services provided by a physician. If these services are provided by the Laboratory, then the appropriate CPT codes from the 80000 code section would be billed. Have a GREAT day!

1 comment:

  1. So cpt 89060 can only be billed when performed in a lab? Not office? If the payer is commercial they may not accept the HCPCS code but suggest the CPT code. A QW modifier would not be appropriate to add to the CPT when billing a commercial carrier as that is a Medicare modifier.