Gastroenterology Coding Alert

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.

"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.

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.

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 be helpful in picking which measures to report, says Eric Sandhusen, MPH, CHC, CPC, director of reimbursement, HIPAA and fiscal compliance with Columbia University department of surgery.

Investigate your software: Some programs, such as T-System Inc.'s T SystemEV program for emergency physicians, provide your physician with an "addendum" to capture the quality measures, says Kristie Risley with Sterling Healthcare in Durham, N.C.

"We're doing the PQRI quality reporting through our electronic medical records. The system looks for certain diagnoses and criteria and checks it against the medication lists and contraindications," says Jennifer Crowell, CPC-EMS, hospital coordinator at a Spokane physician practice in Washington.

Example: The system will first determine whether the patient has Medicare and, if yes, then compare the CPT and ICD-9 codes against those included in Measures 60 through 63, which are:

• Measure #60: Gastroesophageal Reflux Disease (GERD): Assessment for Alarm Symptoms

• Measure #61: Gastroesophageal Reflux Disease (GERD): Upper Endoscopy for Patients with Alarm Systems

• Measure #62: Gastroesophageal Reflux Disease (GERD): Biopsy for Barrett's Esophagus

• Measure #63: Gastroesophageal Reflux Disease (GERD): Barium Swallow -- Inappropriate Use.

Tip: Work with your software vendor to make sure your system can accept the PQRI codes as valid, Risley says. Because these codes have no payment amount, you could try listing them as having a reimbursement of $0.01 so your software can accept them.