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Correct CPT code for PQRS reporting

Donna Posted Mon 16th of July, 2012 20:23:46 PM

Can you please tell me if '1000F' is correct for PQRS reporting for Tobacco use. We are getting these denied when we file these
to Palmetto-NC. stating M79 Missing/incomplete/invalid charge.
Thanks in advance for your help!
Donna

SuperCoder Answered Mon 16th of July, 2012 22:49:34 PM

Hi there! That is the CPT Category II code for tobacco use. If you are reporting the PQRS measure 226 for Tobacco Screening and Cessation Intervention, you'll report several codes (numerator and denominator). According to page 537 of 2012 PQRS Specifications guide, you'll follow this information for reporting measure 226 (you can find the whole document at https://www.cecity.com/pqri/2012/2012_PhysQualRptg_MeasureSpecificationsManual_122311.pdf).

If your patient was not screened (but instead had asthma or heart disease) and you want to add a measure for that, the rules are different and we can send you the instructions for that as well.

Measure 226 is to be reported once per reporting period for patients seen during the reporting period. This measure is intended to reflect the quality of services provided for preventive screening for tobacco use.
Measure Reporting via Claims:
CPT codes, Healthcare Common Procedure Coding System (HCPCS), and patient demographics are used to identify patients who are included in the measure’s denominator. CPT Category II codes are used to report the numerator of the measure.
When reporting the measure via claims, submit the appropriate CPT codes, and the appropriate CPT Category II code OR the CPT Category II code with the modifier. The modifiers allowed for this measure are: 1P- medical reasons, or 8P- reason not otherwise specified. All measure-specific coding should be reported on the claim(s) representing the eligible encounter.
Measure Reporting via Registry:
CPT codes and patient demographics are used to identify patients who are included in the measure’s denominator. The numerator options as described in the quality-data codes are used to report the numerator of the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.
DENOMINATOR:
All patients aged 18 years and older
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Patient encounter during the reporting period (CPT): 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90815, 90845, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 97003, 97004, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0438, G0439
NUMERATOR:
Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation counseling intervention if identified as a tobacco user
Version 6.2 12/23/2011
CPT only copyright 2011 American Medical Association. All rights reserved Page 537 of 655
Definitions:
Tobacco Use – Includes any type of tobacco
Cessation Counseling Intervention – Includes counseling or pharmacotherapy
NUMERATOR NOTE: In the event that a patient is screened for tobacco use and identified as a user but did not receive tobacco cessation counseling report 4004F with 8P
Numerator Quality-Data Coding Options for Reporting Satisfactorily:
Patient Screened for Tobacco Use
CPT II 4004F: Patient screened for tobacco use AND received tobacco cessation (intervention, counseling, pharmacotherapy, or both), if identified as a tobacco user
OR
Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco
CPT II 1036F: Current tobacco non-user
OR
Tobacco Screening not Performed for Medical Reasons
Append a modifier (1P) to CPT Category II code 4004F to report documented circumstances that appropriately exclude patients from the denominator
4004F with 1P: Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy)
OR
Tobacco Screening not Performed Reason Not Specified
Append a reporting modifier (8P) to CPT Category II code 4004F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.
4004F with 8P: Tobacco Screening not performed, reason not otherwise specified
RATIONALE:
There is good evidence that tobacco screening and brief cessation intervention (including counseling and pharmacotherapy) in the primary care setting is successful in helping tobacco users quit (USPSTF, 2003). Tobacco users who are able to stop smoking lower their risk for heart disease, lung disease, and stroke (USPSTF, 2003).

Donna Posted Tue 17th of July, 2012 13:16:11 PM

SuperCoder
Thanks So Much!!!
Donna

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