Radiology Coding Alert

Question: Where can I find Medicare's 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 Sept. 28 effective and implementation date. You can find it online at www.cms.hhs.gov/transmittals/downloads/R1761CP.pdf.

The transmittal 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 diagnosis (not primary), payers consider the clinical trial service therapeutic (not diagnostic).

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."

Caution: 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.

-- The answers for You Be the Coder and Reader Questions were reviewed by Michele Midkiff CPC-I, PCS, RCC, executive director of Coding Affiliates Inc., an interventional and neuro-interventional radiology coding service in Mountain View, Calif.