Oncology & Hematology Coding Alert

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.