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Oncology & Hematology Coding Alert

You Be the Coder:

153.x Sets You Up for Physician Quality Reporting

Published on Tue Jan 11, 2011

Question: I want to be sure I'm reporting PQRI measure 72 correctly for 2011. We use claims based reporting. As an example, a 67-year-old patient has been diagnosed with a stage IIIA malignant neoplasm in the descending colon. He presents to our office as a new patient (level-5 office visit) referred for chemotherapy following surgery for the tumor. The oncologist prescribes the FOLFOX regimen. How should we report this case? Answer: Physician Quality Reporting (CMS dropped the "I," which stood for "Initiative") requires a multitude of elements. First, check to be sure your patient is eligible. Measure 72 requires the patient: To be 18 or older (your patient is 67) To have a colon cancer diagnosis that falls under 153.x or V10.05 (Personal history of malignant neoplasm; large intestine) (your patient's diagnosis is 153.2, Malignant neoplasm of colon; descending colon) To present for a new patient (99201-99205) or established patient [...]
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