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Nurse Midwife (GEN)
Posted August 3, 2007
A recent question in relation to coverage of code 87210QW (wet mount for infectious agents) was raised in relation to the defined functions of a midwife - "The primary preventive reproductive health of essentially healthy women, as specified in a written practice agreement," with a specified qualified physician or facility. That definition suggests screening activities. While screening may be correct in medical care, in the Medicare program, screening cannot be covered by statute, other than exempted preventive measures.
In those instances when a woman is free of symptoms or identified disease, code 87210QW would not be covered by Medicare. If the wet mount identifies a disorder, then subsequent testing could be covered in relation to the disorder identified. If the patient has signs, symptoms, or identified disease, then a wet mount could be covered. We would expect to see claims for code 87210QW from certified nurse midwives (CNMs) or other providers with a GA modifier, Advance Beneficiary Notice (ABN) on file; GZ modifier, not reasonable and necessary; and GY modifier, statutorily excluded; or none of the preceding modifiers when appropriate. The screening exclusion would apply to all providers, not just those who are nurse midwives. |
