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Oncology & Hematology Coding Alert

READER QUESTIONS:

Don't Be Found Guilty of Miscoding Clinical Trial

Published on Tue Aug 09, 2005

Question: What diagnosis codes should I use on a claim for a patient involved in a clinical trial?


Washington Subscriber


Answer: You need to know which codes to report - the disease and a V code - and the order in which to report them.

First, report the disease being treated or studied as your primary diagnosis. Then add V70.7 (Examination of participant or control in clinical research).

Example: You have a patient with bladder cancer enrolled in a clinical trial to study the effects of combination chemotherapy in patients with bladder cancer. First, report the bladder cancer with a 188.x code (Malignant neoplasm of bladder). Then apply V70.7 to  the claim.

By reporting the V code as secondary, you're telling the payer that you didn't provide the service to a control group or trial volunteer, meaning the service should be covered. For more information, see CMS Program Memorandum AB-01-142 at www.cms.hhs.gov/manuals/pm_trans/AB01142.pdf.
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