Gastroenterology Coding Alert

See how other coders make sure their doctors provide the right info Practices are gearing up to participate in the Physician Quality Reporting Initiative (PQRI), and they're finding ways to adapt to the PQRI's requirements -- and you can learn from their examples. Remember: You can report only the minimum of three measures during the time period or more if they apply. You just have to report at least three measures during the reporting period at least 80 percent of the time when that measure applies to any patient the physician sees. And you must include the rendering physician's National Provider Identifier (NPI) number with the claim. Focus on Encounter Forms "We are adding the codes to our encounter forms, including the modifiers, with instructions to use them if a patient is to be excluded," says Bob Lloyd, CEO of a physician's practice in Nashville, Tenn. Note: Your physician may already be doing the things that PQRI asks about but not documenting them. Inform your physicians of what they need to document in their reports by looking at the PQRI measures your practice has decided to take on, then all you need to do is extract the information. For a hospital-based practice, "it's important to obtain documentation directly from the hospital," says Donna Allshire, operations director with Professional Emergency Physicians in Fort Wayne, Ind. Reference Sheets Rev Up Compliance Allshire's staff created a special reference sheet, listing diagnosis codes along with the measures that go with them. First, the coders will turn every Medicare chart sideways or pull it out of the stack. Then the coders can look through specifically for places to add the PQRI measures. "I'm sure for the first month this will slow our coding staff down, and their productivity will drop," Allshire says. "But we are hoping this will improve as everyone gets used to the new measures." Also, you can create an attachment to your practice's fee slips with measures listed on them. This will remind the physicians to document any measures and then mark them on the attachment. Use information from the latest version of Coding for Quality: A Handbook for PQRI Participation, which you can download from www.cms.hhs.gov/pqri (click on "educational resources"). Watch out: You need a separate space for the physician to note whether he performed these quality measures -- even if the information is already in the chart somewhere, says Jackie Davis-Willett, CHMBE, president and CEO of TERM Billing in Mansfield, Texas. Check Out These Other Resources Medicare has finally published a "PQRI Code Master," which is an Excel spreadsheet of ICD-9 diagnosis and CPT codes, along with the measures that apply to them (also available at www.cms.hhs.gov/pqri). This could [...]