General Surgery Coding Alert

Check CMS’s complete list for your practice.

Depending on the type of procedures your general surgeons routinely perform, a host of different quality measures might help you avoid the coming penalties for non-participation in Physician Quality Reporting System (PQRS).

For instance: Perioperative care measures could broadly apply to many general surgeons, as follows: 

• Measure #20 Perioperative Care: Timing of Prophylactic Parenteral Antibiotic – Ordering Physician

• Measure #21 Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin

• Measure #22 Perioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics (non-Cardiac procedures)

• Measure #23 Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (when indicated in all patients).

In order to report on the Perioperative Care Measures Group, surgeons must make sure they  identify 20 patients (majority Medicare) by the end of the measurement year who have a procedure from the approved list, which includes common services such as hernia repair codes 43332-43337 (Repair, paraesophageal hiatal hernia …).

Check these, too: General surgeons might also use the PQRS General Surgery Measures Group, which includes the following:

• Measure #354 Anastomotic Leak Intervention

• Measure #355 Unplanned Reoperation within the 30 Day Postoperative Period

• Measure #356 Unplanned Hospital Readmission within 30 Days of Principal Procedure

• Measure #357 Surgical Site Infection (SSI)

• Measure #358 Patient-Centered Surgical Risk Assessment and Communication.

Your surgeon would need to meet the same 20-pateint threshold for procedures from the approved list for this measure, such as colectomy procedures in the range 44140-44151 (Colectomy…).

Use ‘crosscutting measure’: For EPs to satisfactorily report PQRS measures this year, a new reporting criterion has been added for the claims and registry reporting of individual measures. EPs or group practices are required to report one cross-cutting measure if they have at least one Medicare patient with a face-to-face encounter. 

For instance: Measure # 130 for patient safety involves documentation in the medical record of current medications for patients 18 years old or older. That means using all resources immediately available on the date of the encounter to document prescriptions, over-the-counter meds, supplements, etc., including information about dosage, frequency, and administration route. 

To see a complete list of approved procedures and read more about the PQRS measures, see www.cms.gov/pqrs.