Crack Your Cardiology PQRI Measures With This Advice
Published on Mon Aug 06, 2007
Experts warn that learning modifiers might be the trickiest part If your cardiology practice wants to participate in the Physician Quality Reporting Initiative (PQRI), you'll need to know which category II codes to report -- and when. See how other practices are preparing, and what you should do to make certain you receive that extra Medicare reimbursement. How It Works What it is: PQRI is a voluntary program that will provide a financial incentive to physicians and other eligible professionals who successfully report quality data related to services provided under the Medicare Physician Fee Schedule between July 1 and Dec. 31, 2007, according to CMS. Common misconception: You don't have to register for the PQRI, experts say. Instead, you just have to start reporting special category II codes on your claims. The category II codes should be on the same claim as the visit they apply to. For example: Your practice sees a lot of patients with coronary artery disease (CAD) who have had a prior myocardial infarction (MI) and therefore decides to report on measure seven. Then, every time a patient comes in with CAD and a prior MI, you will examine the documentation to see whether your physician prescribed beta-blocker therapy. If the physician did, you will add CPT code 4006F (Beta-blocker therapy, prescribed [CAD, HF]) to the claim. Master Your PQRI Modifiers If the physician didn't, you'll have to learn to use four new modifiers to explain why. These modifiers "are the most difficult piece to understand," says Kristie Risley with Sterling Healthcare in Durham, N.C. If the physician did not prescribe beta-blocker therapy for medical, patient or system reasons, you'll add one of these modifiers to 4006F:
• 1P -- Documentation of medical reason(s) for not prescribing beta-blocker therapy
• 2P -- Documentation of patient reason(s) for not prescribing beta-blocker therapy
• 3P -- Documentation of system reason(s) for not prescribing beta-blocker therapy. If the physician didn't prescribe beta-blocker therapy for an unknown reason, you'll add modifier 8P (Beta-blocker therapy was not prescribed, reason not otherwise specified) to 4006F. But in that case, send the chart back to the physician asking for more information to limit the use of modifier 8P, says Sandra Pinckney, CPC, coder at Certified Emergency Medicine Specialists in Grand Rapids, Mich. Using 8P means the physician is not taking credit for that service. Result: If your quality reporting meets standards, you get an extra 1.5 percent of all of your Medicare billings from July 1 to Dec. 31. To receive the bonus, your doctor must report on up to three measures per claim. Recipe for success: Remember that how many measures may apply to your patients doesn't matter, says Robert La Fleur, MD, an emergency [...]
