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PQRS Codes for Cataract Surgery

Susan m Posted Wed 25th of March, 2015 11:44:36 AM

Could you please tell me the correct PQRS codes (Measure #193) for the following:

Cataract surgery ASA 00142 with MAC anesthesia

1) Over 60 minutes duration

2) Under 60 minutes duration

Thanks so much!

SuperCoder Answered Wed 25th of March, 2015 21:16:54 PM

Thanks for your question. For PQRS measure 193 you’ll need at least two codes on the claim whenever you report measure 193, except when the case is less than one hour. The first code, known as the numerator, is a Category II code that represents the measure. The second, or denominator, is the applicable anesthesia code. The numerator options include:
4250F -- Active warming used intraoperatively for the purpose of maintaining normothemia, OR at least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (CRIT)
4255F -- Duration of general or neuraxial anesthesia 60 minutes or longer, as documented in the anesthesia record (CRIT) (Peri2)
4256F -- Duration of general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record. (CRIT) (Peri2)
When a case doesn’t meet the code criteria because of anesthesia technique or not reaching the required temperature, append a modifier for explanation. Your two choices are:
Modifier 1P -- Intentional hypothermia OR active warming not indicated due to anesthetic technique: peripheral nerve block without general anesthesia, OR monitored anesthesia care
Modifier 8P -- Active warming not performed OR at least one body temperature equal to or greater than 36 degrees Centigrade not achieved within designated time frame, reason not otherwise specified.

You may also need to code one of these two codes, G9362 or G9363. G9362; Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record and G9363; Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record. See the attached articles for more information regarding this measure.

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html (see the 2015 PQRS individual measure guide and go to page 304)

https://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/warm-up-to-measure-193-for-pqri-credit-article

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