Pathology/Lab Coding Alert

And see how to do your measure calculation.

Pathologists have five possible measures they can report in 2013 for the Physician Quality Reporting System (PQRS). If you perform these services, failing to participate in PQRS can cost you, as you just learned in “Maximize Potential ‘Quality’ Pay With These 4 Steps.”

Clip the Codes

For a handy reference tool, the following table lists the five pathology measures, the associated CPT^® Category II or HCPCS Level II codes, and what they mean:

* Modifier 1P - Performance Measure Exclusion Modifier due to Medical Reasons

+ Modifier 8P - Performance measure reporting modifier - action not performed, reason not otherwise specified

Check specifications: “For each quality measure, CMS provides a specification that lists the possible CPT^® code(s) and ICD-9 code(s),” explains Peggy Slagle, CPC, coding and compliance manager for the department of pathology/microbiology at the University of Nebraska Medical Center in Omaha.

For instance: A case qualifies for measure #99 if the pathologist performs either 88307 (Level V - Surgical pathology, gross and microscopic examination, Breast, excision of lesion, requiring microscopic evaluation of surgical margins or Breast, mastectomy - partial/simple) or 88309 (Level VI - Surgical pathology, gross and microscopic examination, Breast, mastectomy - with regional lymph nodes) and the diagnosis code is from the range 174.0-174.9 (Malignant neoplasm of female breast) or 175.0-175.9 (Malignant neoplasm of male breast).

Calculate Your Measure Ratio

Each PQRS measure is reported as a ratio. “The denominator describes all eligible cases for the measure for the reporting year, meaning all cases that have one of the specified CPT/ICD-9 code combinations, whether or not you list a PQRS code,” Slagle says.

The numerator describes the number of cases (claims) for the reporting year that include a PQRS code — whether you met the performance standard or not (such as a PQRS code with modifier 1P or 8P). “In other words, the numerator accounts for the fact that you reported the performance measure, not whether you met the performance standard,” Slagle says.

The ratio translates to the threshold requirement for receiving PQRS bonus pay. In many cases, you’ll need to report PQRS data on 50 percent or more of eligible cases to qualify for the bonus.