Oncology & Hematology Coding Alert

Question: Where can I find the official rule on using V70.7 on clinical trial claims with modifier Q1?

California Subscriber

Answer: As of publication time, the most recent update is CMS transmittal 1761, released June 26 and with a September 28 implementation date. You can find it online at www.cms.hhs.gov/transmittals/downloads/R1761CP.pdf.

It updates the Medicare Claims Processing Manual, Chapter 32, Section 69.6, by eliminating the need to distinguish between diagnostic and therapeutic clinical trial services on your claim.

Here's how: The pre-Sept. 28 rule is that if you report modifier Q1 (Routine clinical service provided in a clinical research study that is in an approved clinical research study) and submit V70.7 (Examination of participant in clinical trial) as a secondary (not primary) diagnosis, payers consider it a therapeutic (not diagnostic) clinical trial service.

But for services on or after September 28, CMS instructs payers to "disable any edits that pertain to clinical trial services being considered diagnostic versus therapeutic based on whether the diagnosis code V70.7 is submitted as the primary or secondary diagnosis."

You still need to be sure that V70.7 has a place on your claim if you report modifier Q1. Otherwise, CMS instructs payers to return the claim as unprocessable.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past president of the AAPC National Advisory Board.