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Oncology & Hematology Coding Alert

Reader Questions:

Toss Secondary Dx Requirement for V70.7

Published on Sun Sep 27, 2009

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 [...]
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