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Pulmonology Coding Alert

Get the Truth on 4 PQRI Myths

Reporting the voluntary measures might financially benefit your practice Before you let enrollment and applicability concerns deter you from participating in CMS' Physician Quality Reporting Initiative (PQRI) program, find out just what it entails and how it affects pulmonology practices. If you want to be eligible for Medicare's 1.5 percent bonus, start reporting quality indicators immediately. Practices whose quality reporting meets the specified standards are eligible for up to 1.5 percent of their total Medicare billings during July 1 to Dec. 31. To receive the bonus, your doctor must report on the selected measures most applicable to your practice. Pulmonologists should select at least three measures in an attempt to receive the total 1.5 percent reimbursement.
Myth 1: Since we didn't enroll, we can't participate Reality: You don't have to register for the PQRI, experts say. Instead, you just have to start reporting special category II codes on your claims. The category II codes should be on the same claim as the visit they apply to. Once you begin to report a specific measure, you must report that measure for the patients to whom it applies throughout the entire six-month period. Check out these two examples of PQRI reporting scenarios that could play out in your pulmonology office. Example 1: Your practice sees a lot of asthma patients and therefore decides to report on measure 53. Then, every time a Medicare patient comes in with asthma, you will examine the documentation to see whether the pulmonologist prescribed either the preferred long-term control medication (inhaled corticosteroid) or an acceptable alternative treatment. If the physician did, you will add 4015F (Persistent asthma, preferred long-term control medication or an acceptable alternative treatment prescribed) and 1038F (Persistent asthma [mild, moderate or severe]) to the claim. If the physician did not prescribe long-term control medication or an acceptable alternative, you will explain why using the codes listed in Figure: Myth 1: Code Chart. Example 2: Suppose your practice sees a lot of patients with community-acquired bacterial pneumonia (CAP) and therefore decides to report on measures 56 through 59. Then, every time a patient comes in with CAP, you will examine the documentation to see whether your physician checked the patient's vital signs. If the physician did, you will add CPT code 2010F to the claim. If the physician didn't check the vital signs, you will still report 2010F, but you'll also attach a modifier explaining why the physician did not perform the check. For example, modifier 1P means the doctor didn't record the patient's vitals for medical reasons. Similarly, you will report 3028F, with or without a modifier, to note whether the pulmonologist checked the patient's oxygen saturation results. And you'll report 2014F for whether [...]