Part B Insider (Multispecialty) Coding Alert

Published on Wed Jun 06, 2007 PDF

Your last-minute PQRI questions answered

As practices ramped up to take part in the Physician Quality Reporting Initiative (PQRI), providers were puzzling over some last-minute questions. We asked our Insider experts to untangle them for you.

Question: The diabetes measures say you should report them once a year, but my physician tests my patient's hemoglobin A1C more frequently. Should we report these results more often?

Answer: You can report the diabetes measures a minimum of once per year, but you can also report them more often, says Dianne Wilkinson, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, TN.

-If I was a physician whose patient just had an A1C of over nine, I-d sure want to report that a couple of months later it was nicely down below seven,- says Wilkinson. -We can run our own internal reports once this data gets in, and it will be nice to do spreadsheets on our diabetics and see what's going on.-

The three A1C codes let you report if the patient's A1C is below seven, between seven and nine, or above nine. Eventually, Medicare may use these codes to reward you for controlling patients- diabetes, notes Deb Arneson with the Kernodle Clinic in Burlington, NC.

Beware: The diabetic measures are only for patients aged 18 to 75, which means many of your Medicare patients won't qualify. This may be a sneaky way of capping your PQRI bonus, Wilkinson suspects.

Question: How can you make sure that the category II codes for the PQRI are linked to the correct diagnosis?

Answer: The Centers for Medicare & Medicaid Services (CMS) has stated that carriers will pick up the PQRI codes that apply to a particular diagnosis and procedure, no matter what order you post them in, says Kevin Arnold, business manager for emergency medicine with Norwalk Hospital. If you have multiple ICD-9 codes that refer to one measure, you only need to list the category II code once. But if you have multiple measures, you should list all of them.