Optometry Coding & Billing Alert

Question: We have been participating in the physician quality reporting initiative (PQRI), and I heard that you could report a measure if your practice is implementing electronic health records (EHR). We started making the transition from paper to digital record-keeping in January 2010; is there an EHR measure in the PQRI pantheon?

Missouri Subscriber

Answer: There is a measure that you can report for using EHR: Measure 124 (Health Information Technology: Adoption/Use of Electronic Health Records [EHR]). According to CMS, providers satisfy the measure when they document "whether provider has adopted and is using health information technology."

Coding: There are no diagnosis coding requirements for this measure. So if a new patient reports to the optometrist for a level-two E/M service and the encounter is documented via EHR, you'll report the following for the encounter:

99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making ...) for the E/M

Either G8447 (Patient encounter was documented using a CCHIT certified EHR) or G8448 (Patient encounter was documented using a qualified [non-CCHIT certified] EHR) to indicate you are reporting PQRI measure 124.

Red alert: In order to report PQRI Measure 124, you must be using an EHR system that is CCHIT certified or, at minimum, "qualified." Check out these quick definitions of certified and qualified systems:

CCHIT certified: Confirm your EHR's specs if you are unsure, but on most Certification Commission for Healthcare Information Technology (CCHIT) certified EHRs, users can:

• manage a medication list
• manage a problem list
• manually enter or electronically receive, store and display laboratory results as discreet searchable data elements meet basic privacy and security elements.

Qualified EHR: In Medicare's eyes, a qualified EHR must satisfy the above requirements and be on its way to certification and fast. "The [qualified] EHR must be CCHIT certified on or before August 1, 2011, or another CCHIT certified product must be in use for compliance after August 1, 2011," CMS states.

To find CCHIT certified EHRs, you can visit the CCHIT web site at: http://www.cchit.org/products.

For more information on PQRI reporting check out: http://www.cms.gov/PQRI/Downloads/2010_PQRI_MeasuresList_111309.pdf.