Anesthesia Coding Alert

If your physician participates in the physician quality reporting initiative (PQRI) program, you have some new codes to include with your measures. If your physician doesn't currently participate in PQRI, experts say 2010 could be a great time to start because tracking measures just got easier -- and will easily add 2 percent to your bottom line.

"It's rare that we can say CMS has made something simpler," Betsy Nicoletti, MS, CPC, owner of MP Consulting in Springfield, Vt., wrote in her e-newsletter Coding Field Notes. "But one piece of good news in the Physician Final Rule is reporting PQRI using a measures group instead of individual measures."

What it means: Nicoletti explains that in 2009, you had to report on 30 consecutive patients to be eligible for the bonus when one of the group measures applied to your practice. "Starting in 2010, you need to report all of the measures in the group, but they do not have to be consecutive," she says.

CMS created two anesthesia-related PQRI clusters that take effect in 2010:

• First cluster -- Perioperative administration of antibiotics (#30) and prevention of catheter- related bloodstream infections (#76). Anesthesiologists often place invasive lines for the perioperative patient and administer the prophylactic doses of antibiotics the surgeon requires.

• Second cluster -- Prevention of catheter-related bloodstream infections (#76) and two new codes for perioperative temperature management: 4255F (Duration of general or neuraxial anesthesia 60 minutes or longer, as documented in the anesthesia record [CRIT]) and 4256F (Duration of general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record [CRIT]). The cluster also includes 4250F (Active warming used intraoperatively for the purpose of maintaining normothermia, or at least one body temperature equal to or greater than 36 degrees Centigrade [or 96.8 degrees Fahrenheit] recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time). Postoperative shivering can increase a patient's metabolic and oxygen needs, so the hypothermia bundle rewards physicians who keep their patients warm and use active warming when needed.

Timetable: Codes 4255F and 4256F were released Sept. 15, 2009, and implemented Jan. 1, 2010. They'll first appear in the 2011 CPT manual.

Why they matter: "One bundle that Medicare uses in the operating room is hypothermia; the other deals with infection by looking at the timing of perioperative antibiotic and catheter-related blood stream infections," explains Scott Groudine, MD, professor of anesthesiology at Albany Medical Center in New York. Anesthesiologists usually have control over these measures, which means they can make a positive impact on both these measures, Groudine says.

Joining the anesthesia measures for PQRI should be simple for most practices because your physicians are already documenting what you need. Keep these tips in mind for implementing measures in your group or doublechecking what you already have in place:

• Pull information from the patient's chart when you're coding the case. Details regarding the type of anesthesia and start and stop times should be right at your fingertips. The chart should even list the drug your provider administered.

• Talk with your providers about consistent documentation.

Some physicians tend to reference drugs by brand names; others use generic. Strive for consistency in what your physicians call most medications so your tracking can be more accurate.

If you're interested in learning more about PQRI measures or if your physician wants to participate, visit CMS (www.cms.hhs.gov/PQRI) or the American Medical Association

(www.ama-assn.org/ama/no-index/physicianresources/17432.shtml).