Results 1 to 2 of 2

Clinical Trial Coding - I know CMS has a guidance for government payers

  1. #1
    Default Clinical Trial Coding - I know CMS has a guidance for government payers
    Medical Coding Books
    I am looking for guidance for coding of routine care associated with a clinical trial. I know CMS has a guidance for government payers, but my question is more specifically to the commercial payers. Per the coding book, DX V70.7 is for the "examiniation of a participant in clinical trial". There is also guidance in the book that states, "The codes are not to be used if the examiniation is for diagnosis of a suspected condition or for treatment purposes...". As an example, an oncology patient comes in for a clinic visit and also for labs, xray, chemo treatment. Does the clinic visit get coded or because there was additional treatment that day does it not get coded? Should all activities be coded with V70.7 if they are required activities for the study (but billable to insurance)?

    Is anyone familiar with this? Any help is GREATLY appreciated.

  2. #2
    Default ecastillo from Miami
    Hello i work in the Clinical Trials Office of a large Hospital.
    if the patient come to hospital for standard of care not related to study protocol there is not need to code ICD V70.7 and modifier Q1.
    Activity that needs to be coded is the ones that benefit the study even if pay by insurance/CMS - Remember many clinical studies benefits from SOC, therefore these procedures, labs, etc. need to be coded with V70.7 and Q1. (Q1 use for outpatient only)
    The services sponsor agree to pay can not be billed to insurance/CMS and need to be transfered from bill send to insurance carrier; these charges are not coded with V70.7 nor modifiers: Q1/Q0.

    Modifier Q0 is used for investigational item itself (we used it mainly for device studies).
    Well I hope this helps. let me know if you need more information.

Similar Threads

  1. Clinical trial medicare
    By LORA CRAWFORD in forum Hematology/Oncology
    Replies: 0
    Last Post: 03-25-2014, 09:28 AM
  2. anyone billing clinical trial services???
    By trarut in forum Compliance General Discussion
    Replies: 1
    Last Post: 03-24-2014, 10:21 AM
  3. Clinical Trial Coding - Have many people work with clinical trials
    By mmorningstarcpc in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 06-18-2009, 06:52 PM
  4. Clinical Trial Modifiers
    By mmorningstarcpc in forum Anesthesia
    Replies: 1
    Last Post: 02-17-2009, 08:02 PM
  5. Clinical Trial Coding
    By mmorningstarcpc in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 11-03-2008, 01:12 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.