# PQRI Codes



## aal (Jan 17, 2013)

Have a measure 30 and 76 question for the state of Pennsylvania

If antibiotics are not pre ordered but they are administered within the time frame, how would you code this with the 4047 and 4048 codes? 

Also, do we need written documentation that the sterile field was done to bill the 6030F? If we do not have the documentation, how would we code it?

Any help would be appreciated.


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## dwaldman (Jan 18, 2013)

"Ordered" includes instances in which the prophylactic parenteral antibiotic is ordered by the clinician performing the surgical procedure OR is ordered by the clinician providing the anesthesia services.

I would double check with the facility, I would believe there would be form that has an order for the antibiotic. If not you can point it out the requirements for the reporting that has to be done and maybe the process can be modified.

 I do see where 4047F 8P states No documentation of order for prophylactic parenteral antibiotics to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)

For the central line, maximal sterile barrier technique, what this requires is for the physician to be familiar with the requirements that the measure sets forth and work on documenting this. There are seven elements (1. Cap, 2. Mask, 3. Sterile Gown, 4. Sterile Gloves 5. Large Sterile Sheet 6. Hand Hygiene 7. 2% Chlorhexidine for Cutaneous Antisepsis (or acceptable alternative antiseptics, per current guideline).

If these elements are not documented, I believe you would have to  use 8P.


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## vballew (Jan 21, 2013)

When you refer to whether it was documented are you referring to having paper documentation or just that it's documented on a hospital website?


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## dwaldman (Jan 24, 2013)

I personally believe one of thetwo have to take place: the physician list the elements of the maximal sterile barrier technique in the procedure note or have a form that has the elements that will be part of the permanent record that the physician has checked mark that those elements were used and then sign/date/time. Sometimes you can find when the nurse are just putting a sticker on the chart or the nurse is documenting with those elements for a joint commission requirement, the physician is not as involved in the documentation of the quality action and since it is reported under their NPI  for PQRS, I believe they should be involved in the documentation.


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## vballew (Jan 24, 2013)

Thanks for your input.


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## Arlene2022 (Mar 13, 2013)

*Pqri*

Does anyone have information on PQRI codes as far as not using "related" codes.
And, does anyone know if there has to be 3 measures on each unique patient - what if our physician only has 1 or 2 codes that are applicable? Will the 1 or 2 codes be counted?
Thank you for any help!


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## dwaldman (Mar 15, 2013)

http://www.cms.gov/Medicare/Quality...ssessment-Instruments/PQRS/MeasuresCodes.html



Click on the tab/link for 2013 PQRS Measure List Implementation Guide once you go to the measure codes section in the above link and go to page 19 to see appendix c

In order to satisfactorily report, it is important to review each method's specific reporting criteria. For additional guidance, refer to the "2013 Physician Quality Reporting System Participation Decision Tree" in Appendix C of the "2013 Physician Quality Reporting System (PQRS) Implementation Guide", which is available below as well as in the "Downloads" section on the link titled Measures Code

http://www.cms.gov/Medicare/Quality...ment-Instruments/PQRS/AnalysisAndPayment.html

2013 PQRS Measure Applicability Validation Documents [ZIP, 343KB] 

Click on the zip file once you have access the above link

2013 PQRS Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures â€“ provides guidance for those eligible professionals who satisfactorily submit quality-data codes for fewer than three PQRS measures, and how the MAV process will determine whether they should have submitted QDCs for additional measures.

• 2013 PQRS Measure-Applicability Validation (MAV) Process Release Notes â€“ the release notes for the changes occurring from the 2012 PQRS Measure-Applicability Validation (MAV) Process.

• 2013 PQRS Measure-Applicability Validation (MAV) Process Flow â€“ a chart that depicts the MAV Process.


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