Neurology & Pain Management Coding Alert

Our 3-step plan will help simplify PQRS reporting.

The 2014 PQRS (Physician Quality Reporting System) includes 285 measures that CMS officially approved. You might be accustomed to tracking the measures associated with back pain, but don’t overlook four others for sleep apnea that could be important to your neurologist.

Step 1: Start By Understanding the Condition

Sleep apnea is a serious disorder characterized by a person’s breathing being interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, which can deprive the brain -- and the rest of the body -- of getting enough oxygen.

There are two types of sleep apnea:

• Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
• Central sleep apnea: Unlike OSA, the patient’s airway is not blocked, but the brain fails to signal the muscles to breathe due to instability in the respiratory control center.

ICD-9 includes several diagnoses for sleep apnea, based on how much information the physician documents about the patient’s case. Your choices are:

• 327.23 – Obstructive sleep apnea (adult) (pediatric)
• 780.51 – Insomnia with sleep apnea, unspecified
• 780.53 – Hypersomnia with sleep apnea, unspecified
• 780.57 – Unspecified sleep apnea.

ICD-10 note: After October 1, 2014, codes G47.30 (Sleep apnea, unspecified) and G47.33 (Obstructive sleep apnea [adult] [pediatric]) will also be acceptable diagnoses for the sleep apnea measures group.

Step 2: Watch for the Measures Group

In 2014, the measures group for sleep apnea includes:

• Sleep apnea: Assessment of sleep symptoms – measure 276
• Sleep apnea: Severity assessment at initial diagnosis – measure 277
• Sleep apnea: Positive airway pressure therapy prescribed – measure 278
• Sleep apnea: Assessment of adherence to positive airway pressure therapy – measure 279.

“Measures groups need to be reported via registry, but the volume of patients reported on is substantially reduced with measures groups,” explains Barbara J. Cobuzzi, MBA, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “PQRS only requires reporting on 20 unique patients when reporting a measures group, and you may complete the reporting retrospectively.”

How it works: A supportive registry company puts the information needed for the measures group into a questionnaire so that you just need to pull patients who fit the sleep apnea patient profile, answer the questions for each patient, and add the information to the registry. You need to enter data for 20 patients, with a majority (at least 11) being Medicare Part B fee-for-service patients. All four measures for each patient within the eligible professional’s patient sample must be reported a minimum of once during the reporting period before you’ll satisfactorily meet the measures group requirements.

Tip: When searching for a quality registry, look for one that counts the number of patients successfully reported on and that lets you know when you have completed the requirement to meet the CMS PQRS successful reporting of the Measure’s Group. Medicare is expected to release a list of qualified registries in late spring or early summer.

Step 3: Steer Clear of Future Penalties

Incentives and penalties related to quality measures will be based on your 2014 reporting. For 2014, CMS sets the incentive payment for satisfactory participation in PQRS at 0.05 percent of the group’s (or physician’s, if reporting as an individual) total allowed Medicare Part B charges for the calendar year.

Important: There will no longer be an incentive for participation beginning in 2015 – only a penalty adjustment for not meeting the reporting criteria. The 2015 penalty will be 1.5 percent of all Medicare Part B charges (based on the 2013 reporting). A 2 percent penalty will apply to 2016 services, based on 2014 reporting.

Resource: For a PDF of CMS information on 2014 PQRS incentive reporting requirements and how to avoid the 2016 payment adjustment, email editor Leigh DeLozer, CPC (leighd@codinginstitute.us).

Future planning: CMS has established CY 2014 (Jan. 1-Dec. 31, 2014) as the reporting period for the CY 2016 payment adjustment. One exception applies to this reporting period, however: Individuals reporting on measures groups via qualified registries will have a 6-month reporting period (July 1-Dec. 31, 2014) for CY 2014 reporting.