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Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away.
If you know the basics and focus your efforts, PQRI reporting can be a breeze and a boon to your bottom line. Check out this rundown on “The Whats?” of PQRI.
What’s In it for Me?
Coders can garner an extra payout for PQRI-eligible patients that your group treats and you code correctly; for 2010, Medicare will fork over a 2 percent bonus if you meet certain criteria.
Lowdown: In order to qualify for the PRQI bonus, you have to report on at least three of 179 PQRI measures in 80 percent of the eligible cases, explains Alice Marie Reybitz, RN, BA, CPC, CPC-H, CHI, a healthcare coding and billing consultant based in Belleair, Fla.
What Extra Coding Work Is Involved?
The devil’s in the details with PQRI reporting. To properly report PQRI measures, you need to report a series of codes that corresponds to a PQRI numerator and denominator, explains Eileen Lane-Coffill, CPC, PCS, senior compliance auditor at Boston’s HMFP Compliance.
Breakdown: “The numerator is the ICD-9 and CPT category I code, and the denominator is the CPT category II code[s],” Coffill says. This category II code is usually an F code — or “PRQI code.”
Get to know the PQRI codes, which you’ll find on this PQRI Web site. The PQRI codes represent the measure that you are reporting on; leave these off a claim, and you cannot count it toward PQRI.
Example: An ED physician provides a level-four ED E/M service to a patient complaining of chest pain; final diagnosis is precordial chest pain. This encounter qualifies for PQRI measure 54 (12-lead electrocardiogram [ECG] performed for non-traumatic chest pain).
Patients who qualify for measure 54 will be common in many EDs, confirms Caral Edelberg, CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth in Jacksonville, Fla. To qualify for PQRI, code this claim as follows:
• Numerator: 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision making of moderate complexity …) for the E/M with 786.51 (Precordial pain) appended to represent the patient’s condition.
• Denominator: 3120F (12-lead ECG performed [E/M]) to represent the PQRI measure. Each measure has its own set of diagnosis requirements. Coders are allowed to report on measure 54 for patients with a diagnosis of precordial pain (786.51).
Some other acceptable diagnoses for measure 54 include:
413.0 (Angina decubitis), 413.1 (Prinzmetal angina),
413.9 (Other and unspecified angina pectoris), 786.50 (Chest pain, unspecified).
Use this: Coding for PQRI without using the PQRI Tool Kit is as futile as flying a kite with no string. Bookmark this site and visit it often to learn how to code each measure.
Adapted from ED Coding Alert. To read a longer version of the article, sign up for a FREE trial on Supercoder and select ‘Emergency Medicine’ as your topic area.
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