ED Coding and Reimbursement Alert

Question: Our ED is reporting for the Physician Quality Reporting Initiative (PQRI). One of the measures we are coding for is No. 28: Aspirin at Arrival for Acute Myocardial Infarction (AMI). Recently one of our physicians provided 46 minutes of critical care for a patient with AMI of the anterolateral wall (initial episode of care). The ED physician did not give the patient any aspirin, but the paramedics in the ambulance did. Do I need a P modifier for this encounter?

New Jersey Subscriber

Answer: No, you do not. According to the PQRI rules for Measure 28, the patient needs to have an ED discharge diagnosis of AMI and must have received aspirin within 24 hours before ED arrival or during the ED stay.

Since the paramedics gave the patient aspirin in the ambulance, you won't need a modifier. On the claim, 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

- 410.01 (Acute myocardial infarction of anterolateral wall; initial episode of care) linked to 99291 to represent the AMI

- 4084F (Aspirin received within 24 hours before emergency department arrival or during emergency department stay [E/M]) to represent the PQRI measure.

P modifier reminder: You can still report PQRI encounters even if the physician does not meet the quality measure -- just remember to include one of the following modifiers to explain why the physician did not meet the measure:

- 1P-- Exclusion modifier due to medical reasons

- 2P -- Exclusion modifier due to patient reasons

- 3P -- Exclusion modifier due to system reasons

- 8P -- Reporting modifier -- action not performed, reason not otherwise specified.