Gastroenterology Coding Alert

Take a look at the new hepatitis treatment codes before you turn down a 2 percent bonus.

Does your gastroenterologist treat patients who have hepatitis C?

Well, you should take an interest in CMS's Physician Quality Reporting Initiative (PQRI). New Category II codes for treatment of hepatitis C could bring Medicare's participation bonus within reach for your office.

To receive the bonus, your physician must report on the selected measures most applicable to your practice. Physicians should select at least three measures in an attempt to receive the bonus, which has been bumped to 2 percent of their total Medicare-allowed charges for 2009, says Barbara Colburn, president and CEO of Total Health Care Solutions in Ocala, Fla.

You don't have to register for the PQRI, experts say. You just have to start reporting Category II codes on your claims. The Category II codes should be on the same claim as the visit they apply to. Once you begin to report a specific measure, you must report that measure for the patients to whom it applies throughout the reporting period. (Learn about the reporting options at www.cms.hhs.gov/PQRI/Downloads/2008PQRIalterrptperiods.pdf.)

Example: Check out this PQRI scenario that could play out in your gastroenterology office.

Your practice decides to report on "Education Regarding Risk of Alcohol Consumption" for its hepatitis C patients. For all your practice's hepatitis C patients aged 18 or older, you will examine the documentation to see whether the doctor counseled them on the risk of alcohol consumption at least once during the 12-month reporting period.

If your physician does counsel the patient on the risks of alcohol, you'll report 4158F (Patient education regarding risk of alcohol consumption performed).

You get the bonus for reporting, not performing: Even if the gastroenterologist doesn't perform the assessment, you should still report 4158F for an eligible case. You just use the appropriate PQRI modifier to indicate why the doctor didn't perform the service:

• 1P -- Performance measure exclusion modifier due to medical reasons

• 2P -- Performance measure exclusion modifier due to patient reasons

• 3P -- Performance measure exclusion modifier due to system reasons

• 8P -- Performance measure reporting modifier -- action not performed, reason not otherwise specified.

History: In March 2007, CMS established PQRI, a voluntary program in which physicians collected and reported their practice data on a set of performance measures between July and December of 2007.-The program is still voluntary, but it's considered a precursor  to a mandatory pay-for-performance (P4P) program.

All carrot, no stick: Medicare does not penalize doctors for poor performance. PQRI "offers Medicare providers nationwide a low-risk opportunity to gain experience with reporting procedures likely to be in-corporated into P4P reimbursement schemes," wrote Jonah-Stulberg, MPH, in the January-March 2008  issue of Quality Management in Health Care, a peer-reviewed journal.

Not everyone's excited about the federal government getting in the business of grading physicians' performance. "When payers actually begin practicing medicine and surgery, then we can talk," says Dianna Hofbeck, RN, CCM, forensic examiner-medical documentation for Amish-Mennonite Affordable Healthcare Ministry and New Jersey chairperson of the National Patient Advocate Foundation.

Hofbeck suggests physicians might want to check into PQRI to see what Medicare is up to. She calls it "a-'forewarned is forearmed' type of strategy."