ED Coding and Reimbursement Alert

Remember, EDs not allowed to report on EHR measure.

EDs that want to participate in Medicare's Physician Quality Reporting Initiative (PQRI), but don't know where to start, should rely on Medicare's online resources in order to hatch a perfect PQRI plan.

Check out this 3-step plan to getting off on the right foot with PQRI:

You should first go to www.cms.hhs.gov/PQRI and familiarize yourself with the guidelines for PQRI reporting. You might want to bookmark this site, as it contains an overview of the program and links to resources you might find useful, such as Medicare's "PQRI Tool Kit."

Refer back to this Web site when your have questions about PQRI; it is the definitive source of PQRI info.

You should then select PQRI measures that line up with your patient panels and the professional services your ED furnishes, says Caral Edelberg, CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth in Jacksonville, Fla. ED coders can check out the 2009 measures at www.cms.hhs.gov/PQRI/Downloads/2009PQRIMeasuresList.pdf.

When you get to the above link, check out these measures, which are relevant to most EDs: 28 54 , 55, 56, 57, 58, and 59.

Next, make sure you are aware of all of the requirements of the measures you are reporting; claims must contain certain ICD-9 and CPT codes in order to qualify for PQRI.

For example, check out the requirements for measure 54, "Electrocardiogram Performed for Non-Traumatic Chest Pain":

- Reporting description: "Percentage of patients aged 40 years and older with an emergency department discharge diagnosis of non-traumatic chest pain and an applicable CPT Category II code for each episode of non-traumatic chest pain occurring during the reporting period," according to CMS.

- Performance description: "Percentage of patients aged 40 years and older with an emergency department discharge diagnosis of non-traumatic chest pain who had a 12-lead electrocardiogram (ECG) performed," CMS reports.

- Eligible cases: In order to report measure 54, the place of service (POS) must be 23 (ED) -- and the patient must have one of the following diagnoses: 413.0, 413.1, 413.9, 786.50, 786.51, 786.52, or 786.59.

Also, the ED physician must provide one of the following services in order to qualify for measure 54: 99281-99285 or 99291. Lastly, you-ll need to report 3120F to ensure that the claim is included in PQRI.

Example: A 46-year-old patient reports to the ED complaining of chest pain over the heart. The physician provides 48 minutes of critical care for the patient, during which time he orders a 12-lead electrocardiogram (ECG
or EKG).

This scenario lines up perfectly for PQRI reporting. On the claim, you would report the following:

- 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care

- 786.51 (Precordial pain) appended to 99291 to represent the patient's condition

- 3120F (12-lead ECG performed [EM]) to show that you are reporting the encounter to PQRI.