Pulmonology Coding Alert

You can even get credit for reporting that a patient did not meet criteria.

All coding conferences this year were abuzz with talk of the Physician Quality Reporting Initiative (PQRI), but many physicians mistakenly think that adopting these reporting measures will prove too complicated.

The truth: PQRI participation is not as hard as it looks, Alice Marie Reybitz, RN, BA, CPC, CPC-H, assured attendees of The Coding Institute's December conference in Orlando, Fla.

In fact, you only need to report a small amount of information on select groups of patients in order to qualify for your 2 percent dividend on Medicare payments. Depend-ing on the reporting method you choose and the type of medicine you practice, you may report on three, two, or even only one measure in order to participate; but the earlier in the year you start, the better.

Get a head start: The first step to earning PQRI incentive revenue is to decide which of the 153 measures you will report. Tip: After selecting your practice's measures, incorporate the corresponding measure screening forms into your medical records, advised Reybitz.

Below, get the breakdown on how to meet reporting standards for two pulmonology-relevant measures. Check out the "Resources" section at the end of this article to access more information on the PQRI program.

Measure: Percentage of patients aged 18 years and older with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) who had spirometry evaluation results documented. Report this measure a minimum of once per reporting period using the most recent spirometry results in the patient record for patients seen during the reporting period.

Why? Evaluation of lung function for a patient with COPD is vital to determine the degree of pulmonary impairment present and whether or not treatments are effective, points out Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta.

For the diagnosis and assessment of COPD, spirometry is the gold standard because it is the most reproducible, standardized, and objective way of measuring airflow limitation.

To arrive at the numerator: Include in the numerator patients with documented spirometry results in the medical record (FEV1 and FEV1/FVC).

Look for most recent documentation of spirometry evaluation results for patients seen during the reporting period; you do not need to limit the search to the reporting period. Review these options for reporting the appearance or absence of spirometry results:

Option A: Spirometry Results Documented

Code: CPT II 3023F (Spirometry results documented and reviewed)

Option B: Spirometry Results Not Documented for Medical, Patient, or System Reasons

Related modifier: Append one of these three modifiers to 3023F to report documented circumstances that appropriately exclude patients from the denominator:

• 1P --" Documentation of medical reason(s) for not documenting and reviewing spirometry results

• 2P --" Documentation of patient reason(s) for not documenting and reviewing spirometry results

• 3P --" Documentation of system reason(s) for not documenting and reviewing spirometry results.

Option C: Spirometry Results Not Documented, Reason not Specified

Append reporting modifier 8P (Spirometry results not documented and reviewed, reason not otherwise specified) to 3023F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

To deduce the denominator: Include in the denominator all patients aged 18 and older with a diagnosis of COPD. Remember, an ICD-9 diagnosis code for COPD and a CPT E/M service code are required to identify patients for denominator inclusion. Applicable codes include:

• ICD-9 codes: 491.0, 491.1, 491.20, 491.21, 491.22, 491.8, 491.9, 492.0, 492.8, 496

• CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245.

Measure: Percentage of patients aged 5 through 40 years with a diagnosis of mild, moderate, or severe persistent asthma who were prescribed either the preferred long-term control medication (inhaled corticosteroid) or an acceptable alternative treatment. This measure is to be reported a minimum of once per reporting period for all asthma patients seen during the reporting period.

Why? Although current guidelines recommend inhaled corticosteroids as the preferred pharmacological treatment for persistent asthma, other long-term control medications are acceptable alternatives, depending on the asthma intensity.

To arrive at the numerator: Include in the numerator patients who were prescribed either the preferred long-term control medication (inhaled corticosteroid or inhaled corticosteroid with long-acting inhaled beta2-agonist) or an acceptable alternative treatment (leukotriene modifiers, cromolyn sodium, nedocromil sodium, or sustained-released methylaxanthines).

Remember, you must be able to document persistent asthma by identifying the patient's symptoms and the use of short-acting bronchodilators.

"Prescribed" includes patients who are currently receiving medication(s) that follow the treatment plan, even if the prescription for that medication was ordered prior to the encounter. To arrive at the mandated "correct combination" of codes, you may have to submit multiple numerator codes.

Option A: Preferred Long-Term Control Medication or Acceptable Alternative Treatment Prescribed (Two CPT II codes are required on the claim form to submit this category):

Option B: Preferred Long-Term Control Medication or Acceptable Alternative Treatment Not Prescribed for Patient Reasons (Two CPT II codes are required on the claim form to submit this category):

• Append modifier 2P to 4015F to report documented circumstances that appropriately exclude patients from the denominator.

• 4015F with 2P (Documentation of patient reason[s] for not prescribing either the preferred long-term control medication or an acceptable alternative treatment), and

• 1038F.

Option C: If patient is not eligible for this measure because patient does not have persistent asthma, report:

Option D: Preferred Long-Term Control Medication or Acceptable Alternative Treatment Not Prescribed, Reason Not Specified (Two CPT II codes are required on the claim form to submit this category):

• Append reporting modifier 8P to 4015F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

• 4015F with 8P (Persistent asthma, preferred long term control medication or acceptable alternative treatment not prescribed, reason not otherwise given), and

• 1038F.

To deduce the denominator: Include all patients aged 5 through 40 years with a diagnosis of mild, moderate, or severe persistent asthma.

Remember, an ICD-9 diagnosis code for asthma and a CPT E/M service code are required to identify patients for denominator inclusion. Applicable codes include:

• ICD-9 codes: 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91, 493.92; and

• CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245.

• PQRI Overview with left-side navigation menu on CMS's Web site: www.cms.hhs.gov/PQRI/01_Overview.asp

• List of 153 2009 PQRI reporting measures: www.cms.hhs.gov/PQRI/Downloads/2009PQRI/MeasuresList.pdf

• 2008 Measure Reporting Specifications (2009 Specs scheduled to print by Dec. 31, 2008): www.cms.hhs.gov/PQRI/Downloads/2008PQRIMeasureSpecs.pdf.