Quality Data Codes Rejected in Error

Providers should be aware that line items containing certain quality data codes (QDCs) on claims submitted during first quarter 2009 may be rejected or returned as unprocessed in error. You have the option of resubmitting affected claims.

The Centers for Medicare & Medicaid Services (CMS) identified a technical problem affecting 20 QDCs used for reporting 13 quality measures through the claims-based method for the 2009 Physician Quality Reporting Initiative (PQRI). As a result, line items containing the following (new for the 2009 PQRI) CPT® Category II codes are rejected or returned unprocessed.

CPT II Code Measure # Measure

3250F 99 Breast Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade

3250F 100 Colorectal Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade

3570F 147 Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy

3016F 173 Preventive Care and Screening: Unhealthy Alcohol Use – Screening

3455F 176 Rheumatoid Arthritis (RA): Tuberculosis Screening

4195F 176 Rheumatoid Arthritis (RA): Tuberculosis Screening

4196F 176 Rheumatoid Arthritis (RA): Tuberculosis Screening

3470F 177 Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity

3471F 177 Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity

3472F 177 Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity

1170F 178 Rheumatoid Arthritis (RA): Functional Status Assessment

3475F 179 Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis

3476F 179 Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis

0540F 180 Rheumatoid Arthritis (RA): Glucocorticoid Management

4192F 180 Rheumatoid Arthritis (RA): Glucocorticoid Management

4193F 180 Rheumatoid Arthritis (RA): Glucocorticoid Management

4194F 180 Rheumatoid Arthritis (RA): Glucocorticoid Management

4148F 183 Hepatitis C: Hepatitis A Vaccination in Patients with HCV

4149F 184 Hepatitis C: Hepatitis B Vaccination in Patients with HCV

0529F 185 Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use

4267F 186 Wound Care: Use of Compression System in Patients with Venous Ulcers

If you have received a message indicating a submitted code wasn’t accepted for reporting purposes, you have two options:

  1. Do nothing. CMS is excluding all cases from the reporting denominator for dates before carriers and Part A/Part B Medicare Administrative Contractors (A/B MACs) could accept the affected CPT® Category II codes, unless inclusion of cases for such dates is more favorable to the provider; or
  2. Seek correction. Providers can seek correction of first quarter (Jan. 1 – March 31) QDC submissions returned as unprocessed. This is recommended for providers who began reporting the affected measures using the Measures Group Consecutive Method during first quarter 2009. If you wish to seek correction, call your carrier or A/B MAC and request a correction beginning April 1. Be prepared to give specific claim information, such as the internal control number (ICN), the beneficiary’s health insurance claim number (HIC), dates of service, and the codes in question.

Providers should continue to submit QDCs as usual, instructs CMS in MLN Matters article MM6397, issued March 4. Once the problem is fixed, you will begin to see the N365 message on the remittance advice as appropriate.

Note: This issue only affects claims-based PQRI reporting and not quality measures reporting through registries. Providers who successfully fulfill PQRI requirements can expect to receive the 2 percent incentive payment for the entire 2009 reporting period.

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One Response to “Quality Data Codes Rejected in Error”

  1. Margie says:

    Please reveiw.

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