Learn the correct CPT code to report chlamydia testing performed in a physician office lab regulated by CLIA. Detailed explanation of the coding options provided.
Table of Contents
Question
On examination, the physician notes a yellowish vaginal discharge with a foul odor. A gram stain is performed in the office by collecting a sample of the discharge and a thin layer is placed on a glass slide. The results show the patient has chlamydia. The lab test was performed in the office which is regulated by federal rules under the Clinical Laboratory Improvement Amendments (CLIA).
How is this lab test reported?
A. 87205-QW
B. 87205-GA
C. 87207-GA
D. 87207-QW
Answer
A. 87205-QW
Explanation
The physician performed a gram stain test in the office to diagnose chlamydia. A gram stain smear is reported with CPT code 87205.
The -QW modifier indicates a CLIA waived test. CLIA (Clinical Laboratory Improvement Amendments) regulations set quality standards for laboratory testing but waive certain simple tests performed in physician office labs from those requirements. To be waived, the test must be simple and have a low risk for an incorrect result. A gram stain qualifies as a CLIA waived test when performed in a physician office lab.
The other coding options provided are incorrect for this scenario:
B. 87205-GA would indicate the gram stain was performed in a physician office lab but is not waived and is subject to more stringent CLIA regulations.
C. 87207-GA is the incorrect CPT code. 87207 is for a special stain for infectious agents and should not be used for a gram stain. The -GA modifier also indicates it is not CLIA waived.
D. 87207-QW uses the incorrect CPT code 87207 for a gram stain. While the -QW modifier correctly notes it is a CLIA waived test, 87207 should only be used for special stains.
Therefore, the gram stain smear performed in the physician office to diagnose chlamydia, which qualifies as a CLIA waived test, is correctly reported as 87205-QW.
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