Otolaryngology Coding Alert

Also watch for opportunities to report the measure’s group for sleep apnea.

CMS finalized 285 individual measures for inclusion in the 2014 PQRS program, including four that address adult sinusitis. Get ready to work these measures into your quality reporting, and make sure your group is set to avoid the 2014 payment adjustment/penalty.

Get Familiar With Changes to ENT Measures

The four new PQRS measures of interest to otolaryngologists are as follows:

• Adult sinusitis: Antibiotic prescribed for acute sinusitis (appropriate use) – measure 331
• Adult sinusitis: Appropriate choice of antibiotic: Amoxicillin prescribed for patients with acute bacterial sinusitis (appropriate use) – measure 332
• Adult sinusitis: Computerized tomography (CT) for acute sinusitis (overuse) – measure 333
• Adult sinusitis: More than one computerized tomography (CT) scan within 90 days for chronic sinusitis (overuse) – measure 334. 

Important: Each of the four measures is only approved for reporting via registry. CMS states that registry-only reporting is standard for new measures, but that CMS will continue to work toward complete alignment and will include the measure(s) for EHR-based reporting in the future, if possible.

Ten measures that were previously reportable by ENTs or their practices are deleted for 2014 and beyond. These include:

• Referral for otologic evaluation for patients with congenital or traumatic deformity of the ear (deleted due to low utilization)
• 8 Functional Communication Measures previously stewarded by ASHA (deleted due to loss of measure owner support)
• Smoking and Tobacco use cessation, medical assistance (deleted due to EHR MU Stage 2 alignment).

Measures group

Although the measures related to otolaryngology might be most familiar to you, don’t forget the measures group for sleep apnea:

• Sleep apnea: Assessment of sleep symptoms – measure 276
• Sleep apnea: Severity assessment at initial diagnosis – measure 277
• Sleep apnea: Positive airway pressure therapy prescribed – measure 278
• Sleep apnea: Assessment of adherence to positive airway pressure therapy – measure 279.

“Measures groups need to be reported via registry, but the volume of patients reported on is substantially reduced with measures groups,” explains Barbara J. Cobuzzi, MBA, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. “PQRS only requires reporting on 30 CMS patients when reporting a measures group, and you may complete the reporting retrospectively.”

How it works: A supportive registry company puts the information needed for the measures group into a questionnaire so that you just need to pull patients who fit the sleep apnea patient profile, answer the questions for each patient, and add the information to the registry. You need to enter data for 20 patients, with a majority (at least 11) being Medicare Part B fee-for-service patients. All four measures for each patient within the eligible professional’s patient sample must be reported a minimum of once during the reporting period before you’ll satisfactorily meet the measures group requirements.

Tip: When searching for a quality registry, look for one that counts the number of patients successfully reported on and that lets you know when you have completed the requirement to meet the CMS PQRS successful reporting of the Measure’s Group.

Steer Clear of Future Penalties

Incentives and penalties related to quality measures will be based on your 2014 reporting. For 2014, CMS sets the incentive payment for satisfactory participation in PQRS at 0.05 percent of the group’s (or physician’s, if reporting as an individual) total Medicare Part B charges for the calendar year.

Important: For 2014 and beyond, CMS has set the penalty for unsatisfactory participation in PQRS at -2 percent of all Medicare Part B charges. There will no longer be an incentive for participation beginning in 2015 – only the 2 percent penalty adjustment for not meeting the reporting criteria.

Resource: For a PDF of CMS information on 2014 PQRS incentive reporting requirements and how to avoid the 2016 payment adjustment, email editor Leigh DeLozer, CPC (leighd@codinginstitute.us).

Future planning: CMS has established CY 2014 (Jan. 1-Dec. 31, 2014) as the reporting period for the CY 2016 payment adjustment. One exception applies to this reporting period, however: Individuals reporting on group measures via qualified registries will have a 6-month reporting period (July 1-Dec. 31, 2014) for CY 2014 reporting.