Internal Medicine Coding Alert

Question: We are in the middle of our year of reporting for the Physician Quality Reporting Initiative (PQRI), and I am confused about diabetes measures 1. I thought you were supposed to report the measures only once a year per patient, but my internist tests my patient's hemoglobin A1c more frequently. Should we report these results more often?

New Jersey Subscriber

Answer: According to the measure description, you can report the diabetes measures more than once a year; in fact, you must report them more than once per patient to qualify for PQRI. You will report measure 1 for your practice's "Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1c greater than 9.0 percent," according to
PQRI guidelines.

According to Medicare's Measure 1 descriptor, "This measure is to be reported for all patients aged 18 through 75 years with diabetes mellitus -- a minimum of once per reporting period."

So let's say the internist reports PQRI Measure 1 for a patient who had an A1c of over nine in March. If the internist decides to re-check the patient's A1c in June, you can report Measure 1 again. Measure 1 lets you report if the patient's A1C is below seven, between seven and nine, or above nine.

Remember that all of the diabetic PQRI measures are for patients 18 to 75, meaning you'll have to be careful to check the ages of your Medicare patients who might be otherwise PQRI-eligible. If you perform Measure 1 for a 77-year-old Medicare patient, you won't be able to report it to PQRI.