ED Coding and Reimbursement Alert

Medicare program's second period began in January Medicare recently renewed the Physician Quality Reporting Initiative (PQRI) for 2008, giving EDs another opportunity to fatten their bottom lines by reporting on certain measures. The basics: The new PQRI period began Jan. 1, 2008, and will run until Dec. 31, 2008, said Eli Berg, MD, FACEP, during his recent Coding Institute teleconference "Best ED Coding Practices: Get on the Right Foot for 2008." This year, Medicare laid out 119 measures for physicians to report, says Michael A. Granovsky, MD, CPC, FACEP, president of Medical Reimbursement Systems Inc. (MRSI), an ED billing company in Woburn, Mass. If you successfully report from the set of quality measures that apply to EDs, you can receive reimbursement for up to 1.5 percent of all your Medicare billings -- the same rate you saw in 2007 -- during the reporting period. Check out this primer on the ED-specific PQRI quality measures. It will show you what measures to report, how to report them, and how to make the whole process more palatable for coders and physicians. Meet the 80 Percent Threshold for PQRI Pay To receive the Medicare bonus, your providers will have to report on at least 80 percent of cases for three measures on the PQRI list, said Berg, who is the CEO of MRSI. The bonus will apply to all allowable Medicare charges, including deductibles and copayments. For now, PQRI scoring is tied only to reporting; however, this is the time to get your systems in order. Ultimately, CMS envisions tying payment to successful performance of these measures, Granovsky says. Focus On at Least 3 Measures The current list of measures contains seven primary ED-relevant entries, Berg said. (For a list of those entries, see "Coders Can Count on These PQRI Resources" on page 43.) Best bet: Find the three measures your ED reports the most and focus on those. For example, if your ED treats a lot of heart attack patients, you might consider focusing on Measure 28 -- "Aspirin at Arrival for Acute Myocardial Infarction (AMI)." If the ED satisfies the PQRI requirements for at least 80 percent of its patients on three measures, it is eligible for the Medicare bonus. Remember to Include Category II Codes For accurate PQRI reporting, you-ll need to code the proper diagnosis and CPT code for the service, then you-ll have to choose a category II code for tracking purposes. If your coding does not line up with PQRI's expectations, don't expect the bonus. Example: You are reporting on Measure 28. According to Medicare's "2008 Physician Quality Reporting Initiative Specifications Document," you should report this measure "each time during the reporting period a patient has been [...]