Primary Care Coding Alert

Your family physician (FP) performs a measure that might qualify for the physician quality reporting initiative (PQRI): however, the patient refuses the described PQRI treatment for religious reasons.

Action: Report the measure as you would have otherwise, with a modifier 2P (Performance measure exclusion modifier due to patient reasons) appended to the Category II code.

"Providers will receive credit for PQRI measures whether modified or not," says Sarah Todt, RN, CPC, CEDC, associate director for QA and compliance at MRSI Inc. in Woburn, Mass.

Any time your FP treats a patient with a PQRI CPTand ICD-9 code trigger, it will count toward your overall score if you report it with a P modifier. CMS created this modifier class so you can get credit for the measure even if the FP cannot perform the described treatment.

Depending on the situation, you should list one of the following modifiers when a PQRI measure is not met:

• 1P-- Performance measure exclusion modifier dueto medical reasons

• 2P-- Performance measure exclusion modifier due to patient reasons

• 3P-- Performance measure exclusion modifier due to system reasons

• 8P-- Performance measure reporting modifier -- action not performed, reason not otherwise specified.

8P caveat: You can use modifier 8P to receive credit for satisfactory reporting -- but use the 8P reporting modifier judiciously, warns Caral Edelberg, CPC, CCSP,CHC, president of Medical Management Resources for TeamHealth in Jacksonville, Fla.

"The 8P modifier should not be used indiscriminately in an attempt to meet satisfactory reporting criteria without regard toward meeting the practice's quality improvement goals," she says.