General Surgery Coding Alert

Get on EHR bandwagon, too.

The cost of ignoring Medicare incentives keeps going up, so whether you’re dragging your feet on quality reporting or electronic health records (EHR), it’s time to get on board.

Let the experts walk you through what’s happening with certain Medicare programs, such as the Physician Quality Reporting System (PQRS), that could impact the bottom line for your general surgery practice.  

Know What Measures Apply

General surgeons have several quality measures that might apply to their practices, depending on the type of procedures they routinely perform. 

For instance: The following PQRS perioperative care measures should broadly apply to many general surgeons: 

• #20 Perioperative Care: Timing of Prophylactic Parenteral Antibiotic – Ordering Physician
• #21 Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin
• #22 Perioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics (non-Cardiac procedures)
• #23 Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (when indicated in all patients).

In order to report on the Perioperative Care Measures Group, surgeons must make sure they 

identify 20 patients (majority Medicare) by December 31 of the 2014 measurement year who have a procedure from the approved list, which includes common services such as hernia repair codes 43332-43337 (Repair, paraesophageal hiatal hernia …). 

Check these, too: General surgeons might also use the PQRS General Surgery Measures Group, which includes the following:

• #354 Anastomotic Leak Intervention
• #355 Unplanned Reoperation within the 30 Day Postoperative Period
• #356 Unplanned Hospital Readmission within 30 Days of Principal Procedure
• #357 Surgical Site Infection (SSI)
• #358 Patient-Centered Surgical Risk Assessment and Communication.

Your surgeon would need to meet the same 20-pateint threshold for procedures from the approved list for this measure, such as colectomy procedures in the range 44140-44151 (Colectomy …).

To see a complete list of approved procedures and read more about the PQRS measures, see www.cms.gov/pqrs.

Look for PQRS Penalty Notifications

The PQRS incentive program feedback reports for the last full program year (2013) are currently available if you’re interested in reviewing yours, said CMS’s Christina Phillips during a recent Open Door Forum call. “There are two different types of reports you can access — one is the NPI identifier level report, the other is a PIN-level report,” Phillips said. An authorized representative will have to sign in to access the report. 

In addition, Phillips said, CMS is sending notification letters by early November to providers who are subject to the 2015 PQRS payment adjustment. Whether an eligible professional (EP) is subject to this penalty (which equals 1.5 percent of your Medicare fee-for-service payments) will depend on the reporting you did in 2013, “so it is important that you access your feedback reports and determine your level of reporting,” she said.

Way out: If you are notified that you’ll be facing the 1.5 percent PQRS penalty in 2015, keep in mind that the penalty increases to two percent in 2016. If your group practice is hoping to avoid that two percent hit, you do have options, said CMS’s Sabrina Ahmed during the call. 

“In 2016, Medicare will apply a modifier to physician payments under the Fee Schedule for physicians in groups with 10 or more eligible professionals,” Ahmed said. “2014 is the performance period for the value modifier that will be applied in 2016. Groups with 10 or more EPs in 2014 can avoid the automatic negative two percent value modifier payment adjustment in 2016 by participating in the PQRS group practice reporting option (GPRO) in 2014 and meeting the satisfactory reporting criteria.”

Embrace EHR for Your Practice

The clock is also ticking for the EHR incentive program, according to CMS’s Elizabeth Holland during the call. “All providers, even those in their first year, have until Feb. 28, 2015 to attest and earn a Medicare incentive for 2014, which is the last date to attest and earn an incentive.” If you do not successfully demonstrate meaningful use, you’ll face a one percent adjustment in your Medicare payments