Modifier Coding Alert

Published on Mon Apr 21, 2014 PDF

Question: My physician is treating a patient for services where we are able to use the Physician Quality Reporting System (PQRS) ICD-9 code trigger. Which performance measure exclusion modifier do I use if the physician withholds aspirin from the patient due to the patient’s history of anaphylaxis from aspirin?

Montana Subscriber

Answer: You would use exclusion modifier 1P with 4084F (Aspirin received within 24 hours before emergency department arrival or during emergency department stay [E/M]), with the proper diagnosis and CPT® codes based on the encounter.

CMS has provided a mechanism to report PQRS codes, even if the described treatment isn’t performed. You append a special modifier to the PQRS code to show that even though the measure wasn’t fully performed, the group is committed to the reporting process.

Depending on the situation, you should list one of the following modifiers when a PQRS measure is not met:

• 1P — Performance measure exclusion modifier due to medical reasons
• 2P — Performance measure exclusion modifier due to patient reasons
• 3P — Performance measure exclusion modifier due to system reasons
• 8P — Performance measure reporting modifier — action not performed, reason not otherwise specified.

Example: A patient presents with an acute myocardial infarction (AMI), but has a history of anaphylaxis from aspirin. The physician documents clinical decision-making related to withholding aspirin during the MI due to the history of severe allergic reaction.

Message from CMS: Eligible professionals should use the 8P reporting modifier judiciously for applicable measures they have selected to report. The 8P modifier may not be used indiscriminately in an attempt to meet satisfactory reporting criteria without regard toward meeting the practice’s quality improvement goals.