Billing & Coding Resources
AmniSure International LLC, a QIAGEN company, is pleased to provide coding resources related to the AmniSure ROM Test through QIAGEN Reimbursement Solutions. You can reach QIAGEN Reimbursement Solutions at 1-877-7-MYQIAGEN (1-877-769-7424).
|AmniSure ROM (Rupture of [Fetal] Membranes) Test|
|CPT 84112||(Placental alpha microglobulin-1 [PAMG-1], cervicovaginal secretion, qualitative)|
|644.03||Threatened premature labor, antepartum condition or complication|
|658.10||Premature rupture of membranes in pregnancy, labor and delivery, unspecified as to episode of care or not applicable|
|658.11||Premature rupture of membranes in pregnancy, labor and delivery, delivered, with or without mention of antepartum condition|
|623.5||Leukorrhea, not specified as infective (vaginal discharge)|
|V22.2/V23.9||Pregnant state, Incidental/Supervision of unspecified high-risk pregnancy|
|V23/23.7||Supervision of high-risk pregnancy/Supervision of high-risk pregnancy with insufficient prenatal care|
|Procedure Description||A sample of vaginal secretion is obtained by a vaginal swab and placed in a vial with a solvent designed to extract the amniotic fluid from the swab. After approximately 1 minute, the swab is disposed and a test strip containing a unique combination of monoclonal antibodies is dipped into the vial with the remaining solution. This test uses principles of immunochromatography to detect presence of the placental a-1 microglobulin, protein marker of amniotic fluid. Over a 5-10 minute period, the sample substance flows throught the test strip. If the placental a-1 microglobulin protein marker is present above a certain threshold level, two gold lines will appear on the test strip signifying ROM. Only one gold line will mean the absence of ROM.|
|Payment||Clinical lab services are paid under the Medicare Clinical Laboratory Fee Schedule. The National Limitation Amount (NLA) for CPT 84112 as determined by the Centers for Medicare and Medicaid Services (CMS) for 2012 is $91.23.|
|Frequently Asked Questions||Q: Does the AmniSure test have FDA Clearance?|
A: Yes, FDA Clearance was received on Fenuary 2, 2004.
|Q: Is additional documentation required when submitting a claim for CPT 84112?|
A: Because CPT 84112 is a new code that has just been issued in 2010, some third-party payers and health plans may not yet have established a reimbursement rate your facility considers suitable. It is therefore crucial to submit this code for reimbursement and to appeal any underpaid claims. You may be asked to submit doctor notes or additional documentation proving that use of the AmniSure ROM Test on a patient was medically necessary to diagnose PROM.
|Q: Why would i go through the extra effort of appealing an underplaid claim?|
A: Simply put, appealing underpaid claims to ensure their proper payment gives medical facilities the opportunity to cover their expenses and recover revenue. Health Insurers save money when they partially pay or deny a claim payment because medical facilities do not always actively pursue appeals. As an example, within five months of implementing an effective claims appeal process, one practice in Chicago was recovering as much as $100,000 per month.1 As a registered user of the AmniSure ROM Test, you will have access to time-saving and effective templates and tools for appealing underpaid or denied claims. For more information on obtaining these resources please visit www.amnisure.com/billing.
1American Medical Association, "Appeal that Claim," 2008.
CPT® is a registered trademark of the American Medical Association.
AmniSure International, LLC is pleased to provide coding resources related to the AmniSure ROM Test strictly for informational purposes. The company thus assumes no risk in promulgating this information, as it is not rendering legal, accounting or other professional services in so doing.
The materials referenced and provided are based upon research of current coding practices. The final decision for coding of any procedure must be made by the provider of care, while considering the medical nature of said procedure and all local, regional, and national laws and regulations.
Furthermore, policies regarding appropriate coding and reimbursement of Common Procedural Terminology® (CPT) codes can vary by region, payer, and contract, and change over time. Specific coding, billing, and reimbursement information surrounding CPT codes should always be obtained directly from contracted payers and AmniSure Interational LLC encourages such action on the part of the provider.