ED Coding and Reimbursement Alert

Coding for the Physician Quality Reporting Initiative (PQRI) can get tricky, especially at first. Discovering ED-relevant measures can take a bit of time, and once you do decide which measures to report, coding questions will inevitably surface.

Good news: Only a handful of measures will apply to most EDs. Also, many Web pages help coders reach PQRI coding success.

Help's here: Keep this list of ED-applicable PQRI measures handy so you can identify the relevant measures. We-ve also included a rundown of the best PQRI Web sites for coding information and instruction.

Here's a list of the quality measures most EDs will choose from, along with their PQRI measure numbers, from the "2008 Physician Quality Reporting Initiative (PQRI) Eligible Professional Quality Measures " (http://www.cms.hhs.gov/PQRI/Downloads/2008PQRIMeasuresList.pdf?agree=yes&next=Accept).

- 28 -- Aspirin at Arrival for Acute Myocardial Infarction (AMI): Percentage of patients, regardless of age, with an ED discharge diagnosis of AMI who received aspirin within 24 hours before ED arrival or during ED stay.

- 54 -- Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain: Percentage of patients 40 and older with an ED discharge diagnosis of non-traumatic chest pain who had a 12-lead ECG.

- 55 -- ECG Performed for Syncope: Percentage of patients 60 and older with an ED discharge diagnosis of syncope who had a 12-lead ECG.

- 56 -- Vital Signs for Community-Acquired Bacterial Pneumonia (CABP): Percentage of patients 18 and older with a diagnosis of CABP (documentation that physician reviewed vital signs is necessary).

- 57 -- Assessment of Oxygen Saturation for CABP: Percentage of patients 18 and older with a diagnosis of CABP with oxygen saturation documented and reviewed.

- 58 -- Assessment of Mental Status for CABP: Percentage of patients 18 and older with a diagnosis of CABP who received a mental status assessment.

- 59 -- Empiric Antibiotic for CABP: Percentage of patients 18 and older with a diagnosis of CABP who received an appropriate empiric antibiotic.

Medicare PQRI handbook: http://www.cms.hhs.gov/PQRI/Downloads/2008PQRICodingforQualityHandbook.pdf

Medicare PQRI FAQ: http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?%20p_pv=3.945&p_prods=8%2C61%2C945&p_cats=&p_hidden_prods=&prod_lvl1=8&prod_lvl2=61&prod_lvl3=945

Medicare PQRI main page: http://www.cms.hhs.gov/PQRI/

AMA PQRI Quality Measures page (Note: This site contains downloadable data collection sheets for each PQRI measure):

http://www.ama-assn.org/ama/pub/category/17493.html

American College of Emergency Physicians (ACEP) PQRI FAQ: http://www.acep.org/practres.aspx?id=30492.