ED Coding and Reimbursement Alert

Medicare will still accept these patients toward PQRI total. Your ED performs a measure that might qualify for the physician quality reporting initiative (PQRI): however, the patient refuses the described PQRI treatment for religious reasons. What to do: Report the measure as you would have otherwise, with a modifier 2P (Performance measure exclusion modifier due to patient reasons) appended to the E/M code. Why? "Providers will receive credit for PQRI measures whether modified or not," says Sarah Todt, RN, CPC, CEDC, associate director for QA and compliance at MRSI Inc. in Woburn, Mass. Any time your ED physician treats a patient with a PQRI ICD-9 code trigger, it will count toward your overall score. CMS has provided a mechanism to report PQRI codes, even if the described treatment isn't performed. You append a special modifier to the PQRI code to show that even though the measure wasn't fully performed, the [...]