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Clinical Trials

  1. Default Clinical Trials
    Medical Coding Books
    I would like clarification on how to appropriately report routine cost associated with clinical trial services using modifier Q1 and secondary diagnosis code V70.7. Should practices report the modifier and diagnosis code to each line item associated with the clinical trial? Also, since the drug is usually supplied by the pharmaceutical company at no cost to the practice we would bill for the administration of the drug. Should we report a J code with a $0 charge and is there a reduction in reimbursement when the Q1 modifier is attached to routine services?

    Below is an example of a claim in question:


    172.8, V70.7


    172.8. V70.7


    172.8, V70.7


    172.8, V70.7


    172.8, V70.7


    172.8, V70.7


    Would the above example be the correct way to report routine cost associated with a clinical trial?

  2. #2
    Default clinical trial response
    placing the Q1 modifier doesn't reduce re-imbursement. As far as placing the modifier with the V70.7 code on each line item, this has been an uncleared question and response from CMS. As a member of the POE chapter of medicare, I have requested a webcast on billing clinical trials. My understanding since the year 2000 and 2007, the modifier with the V70.7 was placed on the administration charge only that is identified as routine cost. the modifier Q0 with the V70.7 is placed on the services that are identified as non-routine cost not affiliated with routine chemotherapy regimens, such U/A. I believe we are probably reading the same CMS guidelines which are confusing to a "coder's language". Looking forward to additional input.

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