Ob-Gyn Coding Alert

Is your ob-gyn 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, surgical procedures, and diagnostic condition evaluations that your ob/gyn may provide. When a physician in your practice treats a Medicare patient, some PQRI dollars might be only a few codes away.

What's In it for Me?

An extra payout for PQRI-eligible patients that your ob-gyn 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 ofthe 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 reportat least 30 patients per PQRI measure per measures group (which is different from an individual measure), or you can submit 80 percent of the eligible cases.

The lowdown: If you report PQRI properly, Medicare will calculate the 2 percent bonus on the physician's total Medicare revenue from all services submitted and paid under the Part B fee schedule.

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/or CPT category I code, and the denominator is the CPT category II code[s] -- usually an F code, or one of the G codes developed specifically by Medicare" Coffill says.

Get to know the F and G codes for the measures you will be reporting. You can find the F codes at the beginning of the Category II codes section in CPT 2010. You'll see the G codes in any book or software product that includes HCPCS codes. You can download the CMS requirements for each measure from www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage. These codes indicate the measure that you are reporting. If you leave the F or G codes off of a claim, you cannot count it toward PQRI.

For instance, one measure your ob-gyn practice might consider tracking is no. 48 (Assessment of presence or absence of urinary incontinence in women aged 65 years and older). You can report this measure only once during a 12 month reporting period.

Example: An established 66-year-old Medicare patient who is currently using an estrogen vaginal cream reports to the ob-gyn for a routine follow-up visit for atrophic vaginitis (627.3). During the visit, the physician also assesses the presence or absence of urinary incontinence.

Code this claim as follows to qualify for PQRI:

• Numerator: 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...)
• Denominator: 1090F (Presence or absence of urinary incontinence assessed) to represent the PQRI measure.

Keep in mind: Most of the PQRI measures are tied to E/M codes, though screenings such as G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) are also PQRI eligible. For each measurewithin 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, experts say.

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 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 measure 48, there are a few other measures that many ob-gyn offices can focus on, including:

Cancer Care: (registry-based submission only for these 2 measures)

• Measure #143 -- Pain intensity quantified
• Measure #144 -- Plan of care for pain

• Measure #71 -- Hormonal therapy for stage IC-III,ER/PR positive breast cancer

• #134 -- Screening for Clinical Depression and Follow-Up Plan

• #47 -- Advance care plan

• #154 -- Risk assessment

• #124 -- Adoption/use of electronic health records (EHR)*

• #130 -- Documentation and verification of current medications in the medical record*

• #39 -- Screening or therapy for osteoporosis for women aged 65 years and older
• #41 -- Pharmacologic therapy

• #131 -- Pain assessment prior to initiation of patient therapy and follow-up

• #20 -- Timing of antibiotic prophylaxis - Ordering physician (when performing abdominal or vaginal hysterectomy)
• #22 -- Discontinuation of prophylactic antibiotics (Non-cardiac procedures) (when performing abdominal or vaginal hysterectomy)
• #23 -- Venous thromboembolism (VTE) prophylaxis (When indicated in ALL patients) (when performing radical vulvectomies, radical hysterectomies or ovarian, tubal or primary pelvic peritoneal surgeries)

Preventive Care and Screening: (Note: All these measures require reporting a problem E/M service. You'll receive no credit if the only time the ob-gyn discusses these with the patient is when the patient comes in for their annual non-covered preventive exam.)

• #110 -- Influenza immunization for patients ≥ 50 years old
• #111 -- Pneumonia vaccination for patients 65 years and older
• #112 -- Screening mammography
• #113 -- Colorectal cancer screening
• #114 -- Inquiry regarding tobacco use
• #115 -- Advising smokers to quit
• #128 -- Body mass index (BMI) screening and follow-up*
• #173 -- Unhealthy alcohol use ��" screening

Urinary Incontinence: (in addition to 48)

• #49 -- Characterization of urinary incontinence in women aged 65 years and older
• #50 -- Plan of care for urinary incontinence inwomen aged 65 years and older

* Code G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) applies to measures 124, 128 and 130 only.