Because our health care system rewards quality of care rather than quantity of care, it underscores the importance of early and accurate diagnosis of clinical conditions. Using point-of-care (POC) testing helps us counteract this issue.
POC testing is becoming more prevalent in the average optometric practice as technology improves and weaves its way into our daily clinical regimen. Much of the POC testing we do today concerns the anterior surface, specifically TearLab osmolarity testing, AdenoPlus (Quidel), InflammaDry (Quidel) and Sjö (Bausch + Lomb). The number of tests and type of testing for conditions, such as macular degeneration, Sjögren’s syndrome and diabetes, continue to increase as new entries come to market.
POC testing is easy and important to incorporate into your daily routine; however, there are some basics to understand before deciding to test, code and bill. In order to incorporate this simple yet important aspect of clinical care into your practice, you must be familiar and accredited with your Clinical Lab Improvement Amendments (CLIA) certification.
Assuming that performing CLIA-waived tests are within your scope of practice, you must do two things before you can perform and get reimbursed for CLIA-waived tests. First, your office must be designated as a CLIA-approved laboratory, and, second, one of the doctors must be designated and approved as a clinical lab director. To do this, you must apply with the Centers for Medicare and Medicaid Services to get your CLIA certification.1 This certification is absolutely critical.
Lab tests are paid from a national laboratory fee schedule and do not follow the RBRVS reimbursement model. The codes are designated in the 8XXXX range in the CPT. Additionally, you can only perform tests that have the “waived” designation and carry the –QW modifier designation.
For testing both eyes and coding for them, include two lines. The claim form looks like the following:
Tests that we typically perform in our practice are:
TearLab—83861-QW (Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity)
AdenoPlus—87809-QW (Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus)
InflammaDry—83516-QW (Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method)
Covering Your Bases
However, not all POC testing is clinical or requires CLIA certification. Tests for Sjögren’s and diabetes require collection of blood that may or may not be within your state’s scope of practice. Keep in mind that while the patient may be able to stick their own finger for the blood sample, you may not be. If you are, this collection is described with CPT code 36415 (routine venipuncture) and pays about $3.
It is important to realize that quantifying and interpreting the results in the medical record—should you have to defend them— is an important part of the clinical regimen. There should always be signs, symptoms, complaints or a personal history of disease recorded in the medical record that would prompt your testing and establish medical necessity for point-of-care tests performed. There are no limitations on the quantity of tests that you can perform in a clinical episode of care, but the number should be reasonable and demonstrate that the testing influenced your clinical decision-making.
Delivering better outcomes by incorporating testing that allows us to diagnose earlier and treat with greater specificity is vitally important in today’s healthcare environment. Incorporating point-of-care testing allows you to be able to do so in an efficient and effective manner.
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|1. Clinical laboratory improvement amendments (CLIA) application for certification. Centers for Medicare and Medicaid Services. www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS116.pdf. Accessed November 1, 2018.|