Part B Insider (Multispecialty) Coding Alert

Published on Thu Mar 15, 2012 PDF

After April, Medicare will count this measure toward PQRS once more.

If collecting a PQRS bonus for your hypertensive patients seemed like an easy way to meet your requirements for this year, CMS has thrown a wrench into your plans, at least for the first quarter of 2012.

"CMS has recently identified an error related to the submission of PQRS Measure number 235 (Hypertension plan of care), for the 2012 PQRS system," CMS's Lauren Fuentes said during a March 6 CMS Open Door Forum. The measure includes six G codes and one CPT code, but all of those G codes were deleted for 2012, causing MACs to deny them. This means that the quality reporting for patients submitted with that measure for January through March "will not be counted," Fuentes said.

The codes in question are as follows, Fuentes said:

• G8675--Most recent systolic blood pressure >=140 mmhg
• G8676--Most recent diastolic blood pressure >=90 mmhg
• G8677--Most recent systolic blood pressure <=130 mmhg
• G8678--Most recent systolic blood pressure 130 to 139 mmhg
• G8679--Most recent diastolic blood pressure <80 mmhg
• G8680 --Most recent diastolic blood pressure 80 to 89 mmhg
• 4050F--Hypertension plan of car documented as appropriate (NMA-No measure associated)

The codes will be reactivated with the next HCPCS update in April, Fuentes said. For 2012 claims-based reporting, the PQRS requires at least three measures be reported at a 50 percent reporting rate. "In the interim, EPs who had intended to report measure 235 via claims may want to consider taking the following steps," Fuentes said.

First, you can consider reporting additional measures to substitute for measure 235, "or alternatively, as hypertension plan of care is a per-visit measure, which requires reporting for 50 percent of eligible patient visits, the EP could report the measure on more than 50 percent of eligible visits for the remainder of the year, April through December of 2012, to increase the likelihood for successful reporting of the measure," Fuentes advised.