Gastroenterology Coding Alert

If your gastroenterology practice is looking to make a few extra bucks for the same services in 2010, Medicare is obliging you yet again.

Back for 2010 is Medicare's incentive-driven physician quality reporting initiative (PQRI), which tracks patient care via E/M services that your gastroenterologists provide. When a physician in your practice treats a Medicare patient, some PQRI dollars might be only a few codes away.

Good news: Coders who have participated in past PQRIs won't have to learn new codes and measures in 2010, reports Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel. The GI-relevant PQRI codes and measures are largely unchanged, he says.

Here's a lowdown on the "Whats" of PQRI to ring in the New Year -- use it as a refresher (or primer) on the basics of this measure-based incentive program.

An extra payout for PQRI-eligible patients that your gastroenterologist treats and you code correctly; for 2010, Medicare will fork over about 2 percent more for these patients. In order to qualify for the PQRI bonus, you have to report on at least three of 179 PQRI measures in 80 percent of the eligible cases, explains Alice Marie Reybitz, RN, BA, CPC, CPC-H, CHI, a healthcare coding and billing consultant based in Belleair, Fla. You'll also need to report at least 30 patients per PQRI measure, Reybitz reminds.

The lowdown: If you report PQRI properly, Medicare will calculate the 2 percent bonus on the physician's total Medicare revenue from all services.

Resource: Check out the PQRI measures list at www.cms.hhs.gov/PQRI/Downloads/2010_PQRI_MeasuresList_111309.pdf.

The devil's in the details with PQRI reporting. "To properly report PQRI measures, you need to indicate a numerator and denominator," explains Eileen Lane-Coffill, CPC, PCS, senior compliance auditor at Boston's HMFP Compliance.

Breakdown: "The numerator is the ICD-9 and CPT category I code, and the denominator is the CPT category II code[s] -- usually an F code," Coffill says.

Get to know the F codes, which you'll find at the beginning of the Category II codes section in CPT 2010. These codes indicate the measure that you are reporting. If you leave the F codes off of a claim, you cannot count it toward PQRI.

One measure your gastroenterology practice might consider tracking is no. 185 (Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps -- voidance of Inappropriate Use). Patients are eligible for measure 185 "each time a surveillance colonoscopy is performed during the reporting period," explains Weinstein, who offers this detailed clinical scenario.

Example: An established 66-year-old Medicare patient reports to the gastroenterologist for a colonoscopy to check for polyps; five years earlier, the same gastroenterologist removed a pair of adenomatous polyps from this patient via colonoscopy. The gastroenterologist identifies colonic diverticulitis, but no new colon polyps.

Code this claim as follows to qualify for PQRI:

Numerator: G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) for the screening, with V12.72 (Diseases of digestive system; colonic polyps) and 562.10 (Diverticulosis of colon without mention of hemorrhage) appended to represent the patient's past history and current condition, respectively.

Denominator: 0529F (Interval of 3 or more years since patient's last colonoscopy, documented [End/Polyp]) to represent the PQRI measure.

Most of the PQRI measures are tied to E/M codes, though screenings such as G0105 are also PQRI eligible, as the above example indicates. "For each measure within the 2010 PQRI Measure Specifications Manual, there is a list of acceptable CPT codes for each PQRI measure and when required the acceptable ICD-9 code," Weinstein points out.

Medicare has set up plenty of online resources.

Use this: Coding for PQRI without using the PQRI Tool Kit is as frustrating as dialing a phone in mittens. The link for the kit is http://www.cms.hhs.gov/PQRI/31_PQRIToolKit.asp#TopOfPage.

Bookmark this site and visit it often. From this page, information regarding how to code each measure properly flows constantly.

Pick three measures to focus on for PQRI. In addition to no. 185, there are a few other measures that most gastroenterology offices can focus on, including:

• 46 -- Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility;

• 83 -- Hepatitis C: Testing for Chronic Hepatitis C -- Confirmation of Hepatitis C Viremia;

• 85 -- Hepatitis C: HCV Genotype Testing Prior to Treatment;

• 89 -- Hepatitis C: Counseling Regarding Risk of Alcohol Consumption;

• 90 -- Hepatitis C: Counseling Regarding Use of Contraception Prior to Antiviral Therapy;

• 113 -- Preventive Care and Screening: Colorectal Cancer Screening;

• 124 -- Health Information Technology (HIT):

• 130 -- Documentation and Verification of Current Medications in the Medical Record;

• 183 -- Hepatitis C: Hepatitis A Vaccination in Patients with HCV; and

• 184 -- Hepatitis C: Hepatitis B Vaccination in Patients with HCV.

Caveat: This list is by no means exhaustive; there are other PQRI measures that might better suit your practice. Coders and physicians might want to have a brief meeting this month to review the measures list and decide which PQRI measures the practice should focus on.