We further detail the measures that will have the most effect on you We continue our series of handy 2008 PQRI charts detailing PQRI measures and the appropriate ICD-9, E/M and PQRI codes to help you code more accurately and ensure your reimbursement. For this issue, we concentrate on PQRI measures related to prostate cancer. Important: Pay close attention to these modifier descriptors to boost your PQRI coding accuracy: - 1P -- exclusion modifier due to medical reasons - 2P -- exclusion modifier due to patient reasons - 3P -- exclusion modifier due to system reasons - 8P -- reporting modifier -- action not performed, reason not otherwise specified. CMS notes that for the following measures: - the patient must be aged 18 years or older - the measure need only be reported once per patient per reporting period. For additional information on the requirements for these measures, please refer to CMS- "Coding For Quality: A Handbook For PQRI Participation." You can find this online at
http://www.cms.hhs.gov/PQRI/Downloads/2008PQRICodingforQualityHandbook.pdf. 101 -- Appropriate Initial Evaluation of Patients With Prostate Cancer ICD-9 diagnosis codes: 185 (Malignant neoplasm of prostate) CPT codes: 55810-55815, 55840-55845, 55866, 55873 (Prostate surgery); 77411-77416, 77418, 77427, 77776-77778 (Radiation treatment); 77784 (Brachytherapy) PQRI codes: 3268F; or 3268F-1P; or 3268F-8P 102 -- Inappropriate Use of Bone Scan for Staging Low-Risk Prostate Cancer Patients ICD-9 diagnosis codes: 185 CPT codes: 55810-55815, 55840-55845, 55866, 55873 (Prostate surgery); 77411-77416, 77418, 77427, 77776- 77778 (Radiation treatment); 77784 (Brachytherapy) PQRI codes: 3270F and 3271F; or 3269F-1P or 3269F-3P and 3271F; or 3272F; or 3273F; or 3274F; or 3269F and 3271F 103 -- Review of Treatment Options in Patients With Clinically Localized Prostate Cancer ICD-9 diagnosis codes: 185 without 197.0-197.8; 198.0-198.89 (Secondary malignant neoplasms) CPT codes: 55810-55815, 55840-55845, 55866, 55873 (Prostate surgery); 77261-77263 (Therapeutic radiology) PQRI codes: 4163F; or 4163F-1P; or 4163F-8P Refer to page 229 of the CMS Handbook for documentation information on this measure. 104 -- Adjuvant Hormonal Therapy for High-Risk Prostate Cancer Patients ICD-9 diagnosis codes:185 CPT codes: 77407-77416, 77418, 77427 (Radiation treatment) PQRI codes: 4164F and G8465; or 4164F-1P or 4164F-2P and G8465 or G8464; or 4164F-8P and G8465 Refer to page 231 of the CMS Handbook for documentation information on this measure. 105 -- Three-dimensional Radiotherapy for Patients With Prostate Cancer ICD-9 diagnosis codes: 185 without 197.0-197.8; 198.0-198.89 CPT codes: 77401-77418, 77427 (Radiation treatment) PQRI codes: 4165F and 4200F; or 4201F; or 4165F-8P and 4200F Refer to page 233 of the CMS Handbook for documentation information on this measure.