Part B Insider (Multispecialty) Coding Alert

Published on Sat Apr 25, 2009 PDF

Plus: Providers collecting under physician fee schedule can collect e-prescribing bonus.

Youve still got time to jump on the PQRI bandwagon, with a new reporting period starting July 1 and extending through Dec. 31, CMS officials noted in a May 20 open door forum on the topic.

For those of you who have not started PQRI, you do have the option of starting by reporting a measures group, said Sylvia Publ, MBA, RHIA, senior quality advisor in CMS office of clinical standards of quality, during the call.

Good news: PQRI bonuses are allowable when reporting measures for patients who have Medicare as a secondary payer, confirmed Michael Rapp, MD, director of the quality measurement and health assessment group at CMS.

During the calls Q&A session, a coder asked what happens when a provider performs a pre-operative service (which is not billable because it counts toward the global surgical fee), but theyre providing a measurable service such as a prophylactic antibiotic for a diabetic patient. The practice wouldnt be billing a CPT code with the quality measure since its covered in the global package.

You would report the perioperative measures on the same claim as the surgery, Publ noted. If you look at the denominator for the perioperative measures, youll see the list of all the procedures, so its driven by the surgical procedure and the claim for that surgery.

Resource: CMS established a QualityNet Help Desk that can give you basic information about measures, participating in the program, etc, Rapp noted. You can reach the help desk at 866-288-8912.

E-prescribing bonuses:

Providers who are paid under the Medicare Physician Fee Schedule, such as physicians, physician assistants, clinical nurse specialists, doctors of optometry, chiropractors, and others, are able to participate in the e-prescribing bonus program.However, Rapp noted, providers paid under other methodologies (such as those provided in federally qualified health centers, portable x-ray suppliers, independent labs, DME suppliers, etc.) arent eligible for the e-prescribing bonus.

Note: You dont need to participate in PQRI to be eligible for the eprescribing incentive bonus.

To read more about PQRI, visit the CMS Web site at www.cms.hhs.gov/PQRI. For more on e-prescribing, visit www.cms.hhs.gov/ERXincentive.