Pulmonology Coding Alert

ATS adds specificity to the bronchodilator measure #52

Come January, and your provider will need to upgrade reporting of COPD and bronchodilator use. Do you know how to fulfill the revised quality measure? Tip: Watch for a new prescription of long-acting bronchodilators requirement.

Background: As of now, the current measure your provider uses is measure 52 (Chronic Obstructive Pulmonary Disease [COPD]: Inhaled Bronchodilator Therapy). This measure

“… didn’t distinguish between long and short acting inhaled bronchodilators,” says Lisa Center, CPC, Physician Practice Manager, Via Christi Hospital Pittsburg, Inc. Pittsburg, KS.

The revision: The new measure now is measure 52 (NQF 0102: Chronic Obstructive Pulmonary Disease [COPD]: Long-Acting Inhaled Bronchodilator Therapy – National Quality Strategy Domain: Effective Clinical Care).

“This revision parallels the treatment guidelines for COPD,” says Carol Pohlig, BSN, RN, CPC, ACS,  senior coding and education specialist at the Hospital of the University of Pennsylvania.

Revised description: Percentage of patients aged 18 years and older with a diagnosis of COPD (FEV1/FVC < 70%) and who have an FEV1 less than 60% predicted and have symptoms who were prescribed a long-acting inhaled bronchodilator.

Rationale for the change: COPD treatment guidelines by the American Thoracic Society (ATS) and other professional organizations require prescription of long-acting bronchodilators for patients with COPD. “Long-acting inhaled bronchodilators are convenient and more effective at producing maintained symptom relief than short-acting bronchodilators” according to the PQRS measure found here: https://pqrsregistry.clinicspectrum.com/2016/individual_measures/052.pdf.

“Physicians are following the correct treatment guidelines, they would be ordering long-acting therapy for qualifying patients,” Pohlig says.

What’s more, “pulmonary physicians are using long acting inhaled bronchodilators as maintenance therapy, resulting in much less utilization of short acting bronchodilators” adds Jeff Berman, MD, FCCP, executive director of the Florida Pulmonary Society.

“The ATS Quality Improvement and Implementation Committee worked with staff at CMS to update the measure to better align with clinical practice guidelines and to improve patient care,” says ATS, in their article in the quarterly newsletter coding and billing quarterly, at www.thoracic.org/about/newsroom/newsletters/coding-and-billing/resources/2016/cbq-october-2016.pdf.

Get ready: CMS has accepted the revision as an administrative change and will implement the revised measure starting January 1, 2017. Providers should make note of the change in the quality measure and ensure they are reporting the revised measure accurately. “It is best to familiarize the physicians and the practice with the revised guidelines, and spot-check the documentation for COPD patients to see if the revised measure is still applicable for reporting on these patients,” Pohlig says.

That’s not all: According to Berman, you will need to ensure that your provider notes down the appropriate type of bronchodilators in the patient’s medical record, to help you bill those correctly.