Modifier Coding Alert
Attach Q0 to a Procedure in a Clinical Trial
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Question: We’ve been billing Medicare implantable cardioverter defibrillator (ICD) implants (33249) with the Q0 modifier when the implant is indicated for congestive heart failure (CHF) or cardiomyopathy diagnoses. It’s always been my understanding that the modifier is for reporting/tracking purposes for Medicare and is diagnosis driven. Now I’ve learned that it’s for investigational devices and the patients must be registered in a clinical trial. What is the purpose of modifier Q0?
Tennessee Subscriber
Answer: Modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study) does indicate that the patient will be registered into the clinical trial national registry by a facility. Physicians are not able to register patients. The facility can only post data to the registry once a quarter which will sometimes mean that by the time they post, the implant may have already taken place.
Code it: Report 33249 (Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead[s], single or dual chamber) with modifier Q0 attached when your provider implants an ICD for CHF or cardiomyopathy.
Consider the possibility that you may need the 8-digit clinical trial (CT) registry number included with your claim to avoid it being returned by CMS.
To see the updated list of diagnosis codes that no longer require the Q0 modifier, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6867.pdf.
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