Anesthesia Coding Alert

If you're still trying to get a handle on this year's PQRI (Physician Quality Reporting Initiative) codes, you aren't alone. Scott Groudine, MD, tackles a question about a back pain code that may apply to your practice.

Question: How are codes 0525F and 0526F billed in conjunction with 1130F , and what are the codes used for?

Florida Subscriber

Answer: The codes you are questioning are among the new 2009 Category II CPT codes used by Medicare to report on the PQRI.

Medicare is the only payer that has incentive payments associated with reporting these tracking codes. Other payers might accept these codes when reported on a valid claim, but currently do not process any of these tracking codes for payment.

What that means in 2009: CMS states that, The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) made the PQRI program permanent, but only authorized incentive payments through 2010. [Eligible professionals] who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, Jan. 1, 2009 through Dec. 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed Medicare charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period (the 2009 calendar year).

The performance measures are organized as fractions with numerator and denominator codes. Numerator codes represent the clinical action performed or desired outcome of the performance measure, while the denominator codes indicate the eligible criteria for the specific performance measure.

Code 1130F (Back pain and function assessed, including all of the following: Pain assessment AND functional status AND patient history, including notation of presence or absence of red flags [warning signs] AND assessment of prior treatment and response, AND employment status) is considered one of the numerator codes used in reporting the new Back Pain Performance Measure for PQRI purposes.

There are many new Category II codes for the PQRI for dates of service on or after April 1, 2008. The other two codes you refer to are considered denominator codes for the Back Pain Performance Measure and are included on that list:

0525F -- Initial visit for episode

0526F -- Subsequent visit for episode.

These three codes carry the M (Measurement codes -- Used for reporting purposes only) status indicator in the Medicare Physician Fee Schedule and carry no reimbursement valuation.

A full list of new Category II codes for PQRI can be found on the CMS Web site as a pdf at www.cms.hhs.gov/transmittals/downloads/R1482CP.pdf.

Scott Groudine, MD, is a consulting editor to Anesthesiology and Pain Management Coding Alert. He is a past President of the New York State Society of Anesthesiologists, Inc., and Professor of Anesthesiology and Surgery at Albany Medical Center, NY. Have a question about anesthesiology or pain management coding? Send them to TOML@eliresearch.com and we may include it in an upcoming issue.

Editor's Note: Audioeducator.com recently hosted an audioconference on this topic entitled 2009 Physician Quality Reporting Initiative Update.” For additional information or to order a CD or transcript copy of the conference,