Master the necessary modifiers to avoid losing out on reimbursement The Physician Quality Reporting Initiative (PQRI) has already begun for 2008. To be sure you-re on the right track, you need to know what this means for you as a coder and how PQRI can affect your bottom line. We give you the information you need to avoid the potential reporting pitfalls. Always Use the Appropriate ICD-9 and CPT Codes Your physicians don't need to enroll or file intent to participate in the PQRI. They can participate by reporting the appropriate quality data codes on claims submitted to your Medicare claims processing contractor. These measures should always be reported with the appropriate ICD-9 and CPT codes. Refer to "We Bring You the 2008 PQRI in a Nutshell" following this article for more details on this. For more information, the PQRI coding handbook is online at
http://www.cms.hhs.gov/PQRI/Downloads/2008PQRICodingforQualityHandbook.pdf. Watch for: "The PQRI code will only be counted and recognized when it is billed on the same claim with the specified CPT codes," says Joyce Matola, billing manager for the Center for Cancer and Hematologic Disease in Cherry Hill, N.J. "All PQRI Category II codes for the PQRI measures must be reported on the same claim with the CPT codes as outlined in the Coding Specifications." You-ll be able to find these codes and much more on the CMS Web Site at
http://www.cms.hhs.gov/PQRI/. There are several PQRI measures that apply to oncology and hematology. These include the following: - 67 -- Baseline cytogenic testing performed on bone marrow - 68 -- Documentation of iron stores in patients receiving erythropoietin therapy - 69 -- Treatment with biophosphonates - 70 -- Baseline flow cytometry - 71 -- Hormonal therapy for Stage IC-III ER/PR positive breast cancer - 72 -- Chemotherapy for Stage III colon cancer patients - 73 -- Plan for chemotherapy documented before chemotherapy administered - 74 -- Radiation therapy recommended for invasive breast cancer patients who have undergone breast conserving surgery - 99 -- Breast cancer patients who have a pT and pN category and histologic grade for their cancer - 100 -- Colorectal cancer patients who have a pT and pN category and histologic grade for their cancer - 101 -- Appropriate initial evaluation of patients with prostate cancer - 102 -- Inappropriate use of bone scan for staging low-risk prostate cancer patients - 103 -- Review of treatment options in patients with clinically localized prostate cancer - 104 -- Adjuvant hormonal therapy for high-risk prostate cancer patients - 105 -- Three-dimensional radiotherapy for patients with prostate cancer. You only have to report on three measures per claim at least 80 percent of the time when that measure applies to [...]
