InflammaDry Reimbursement Guidelines

Recommended CPT^® Code
The assigned CPT (Current Procedural Terminology)¹ code for the InflammaDry MMP-9 Test is 83516, “immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semi-quantitative, multiple step method.” For Medicare and Medicaid claims, add a QW modifier to indicate test is CLIA waived.² Given that payers have varied policies, it is possible that certain payers have different coding requirements. If performing bilateral testing (testing both eyes), you may need to add one of the following modifiers to denote that each eye was tested:

•  83516QW-RT, 83516QW-LT 

•  83516QW, 83516QW-59 (-59 modifier indicates that it is a distinct procedural service) 

•  83516QW-50 with a single unit of service (-50 indicates that it is a bilateral procedure) 

Note: The InflammaDry test is a single use item. Bilateral testing requires two separate InflammaDry tests. 

Related diagnostic codes
There can be many ICD-10 codes that will be related to your need to provide clinical lab testing for a dry eye diagnosis and/or dry eye symptoms. It is important when providing diagnoses related to the testing performed, that you provide the most specific diagnoses that you can in accordance with ICD rules and guidelines. That means relating both laterality and severity if possible. Generalized diagnoses may get reimbursed but are more difficult to defend should your record be scrutinized.

Advance Beneficiary Notice of Noncoverage (ABN)
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service – FFS) beneficiaries in situations where Medicare payment is expected to be denied for lack of medical necessity/reasonableness. The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances.³

An ABN form in its original format must be used for all Medicare Part B patients. If your patient is a Medicare Part C (Medicare Advantage) patient, each carrier may have their own specific format that they will require you to use. Please check with the individual carrier for specifics. Commercial carriers will generally accept the CMS format for having an ABN on file. 

Please remember that the ABN must be completed prior to the procedure being performed. 

Visit quideleyehealth.com/compliance to access an ABN template specific to Quidel’s InflammaDry test. 

Reimbursement support
For reimbursement support, please contact CodeMap^® at quidel@codemap.com or 312.291.8408. Or you may visit our reimbursement website at https://www.codemap.com/quidel. 

This information is being provided as a reference, for informational purposes only, with no expressed or implied warranty and does not purport to provide legal or certified coding advice. It is the sole responsibility of the health care provider of service to verify reimbursement policies and select the appropriate CPT and ICD-10- CM codes to accurately reflect patient condition(s) and testing procedure(s). Any review, retransmission, dissemination or other use of this information by persons or entities other than the intended recipient is prohibited. 

Under Federal and State law, it is the individual provider’s responsibility to determine appropriate coding, charges and claims for a particular service. Policies regarding appropriate coding and payment levels can vary greatly from payer to payer and change over time. Quidel Corporation strongly recommends that providers contact their own regional payers to determine appropriate coding and charge or payment levels prior to submitting claims. 

QuickVue Adenoviral conjunctivitis Reimbursement Guidelines

Recommended CPT^® Code
The assigned CPT (Current Procedural Terminology)¹ code for the QuickVue Adenoviral conjunctivitis Test is 87809. For Medicare and Medicaid claims, add a QW modifier to indicate test is CLIA waived.² Given that payers have varied policies, it is possible that certain payers have different coding requirements. If performing bilateral testing (testing both eyes), you may need to add one of the following modifiers to denote that each eye was tested:

•  87809QW-RT, 87809QW-LT 

•  87809QW, 87809QW-59 (-59 modifier indicates that it is a distinct procedural service) 

•  87809QW-50 with a single unit of service (-50 modifier indicates that it is a bilateral procedure) 

Note: The QuickVue Adenoviral conjunctivitis Test is a single use item. Bilateral testing requires two separate tests. 

Related diagnostic codes
There can be many ICD-10 codes that will be related to your need to provide clinical lab testing for adenoviral conjuctivitis. It is important when providing diagnoses related to the testing performed, that you provide the most specific diagnoses that you can in accordance with ICD rules and guidelines. That means relating both laterality and severity if possible. Generalized diagnoses may get reimbursed but are more difficult to defend should your record be scrutinized. 

Reimbursement support
For reimbursement support, please contact CodeMap^® at quidel@codemap.com or 312.291.8408. Or you may visit our reimbursement website at https://www.codemap.com/quidel. 

This information is being provided as a reference, for informational purposes only, with no expressed or implied warranty and does not purport to provide legal or certified coding advice. It is the sole responsibility of the health care provider of service to verify reimbursement policies and select the appropriate CPT and ICD-10-CM codes to accurately reflect patient condition(s) and testing procedure(s). Any review, retransmission, dissemination or other use of this information by persons or entities other than the intended recipient is prohibited. 

Under Federal and State law, it is the individual provider’s responsibility to determine appropriate coding, charges and claims for a particular service. Policies regarding appropriate coding and payment levels can vary greatly from payer to payer and change over time. Quidel Corporation strongly recommends that providers contact their own regional payers to determine appropriate coding and charge or payment levels prior to submitting claims. 

¹CPT is a copyright and registered trademark of the American Medical Association (AMA). Please consult the current CPT Manual for full descriptors and instructions regarding the use of CPT codes. 

²CLIA stands for Clinical Laboratory Improvement Amendments and is a registration with the U.S. Department of Health and Human Services that allows physicians or medical office personnel to collect a sample and perform a laboratory test within their office. 

³https://www.cms.gov/medicare/medicare-general-information/bni/abn.html