Cardiology Coding Alert

Question: A coding colleague of mine said that we're supposed to use the new Q0 modifier instead of QR for ICD implants. Is that right? And is it Q the-letter-"O" or Q-zero?

Michigan Subscriber

Answer: This modifier is "Q" and the number zero. Modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study) became effective on Jan. 1 of this year.

You'll use this new modifier to differentiate between routine and investigational clinical services. In other words, when you use modifier Q0, you're saying your cardiologist performed a service in which the provider took part in an investigational study's objective and submitted the data. Under Medicare, these items or services can be approved, unapproved, or otherwise covered (or not covered).

Medicare patients who receive an ICD or replacement ICD as a primary prevention of sudden cardiac death must be enrolled in a data collection system. Otherwise, Medicare may not cover the procedure. Appending modifier Q0 to an ICD insertion code (such as 33249, Insertion or repositioning of electrode lead[s] for single- or dual-chamber pacing cardioverter-defibrillator and insertion of pulse generator) says that you've submitted this data to support the objective of an investigational clinical service.

FYI: You'll use modifier Q0 not only for patients meeting the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) coverage criteria but also for Multicenter Automatic Defibrillator Implantation Trial I (MADIT I), MADIT II patients, and class IV heart failure patients qualifying for cardiac resynchronization therapy.

Note: Medicare also added modifier Q1 (Routine clinical service provided in a clinical research study that is in an approved clinical research study). This represents the routine service.

What they replace: HCPCS 2007 specified that you should use these modifiers when beneficiaries take part in clinical research studies (or clinical trials):