Radiology Coding Alert

Here's how to take some of the hassle out of this initiative

You've got to make Physician Quality Reporting Initiative (PQRI) coding as simple as possible for it to be worth the trouble, and this chart can help you on your way.

Reality: The potential bonus of 1.5 percent of allowed charges will cover about 10 percent of this program's costs, says Stephen Levinson, MD, author of the American Medical Association's Practical EM: Documentation and Coding Solutions for Quality Health Care. If a typical physician receives an extra $1,500 for all this work, this translates to 75 cents an hour.

Smart move: Refer to the "Measures/Codes" link at www.cms.hhs.gov/PQRI for exact instructions on reporting the codes. Don't miss: Check out "Coding for Quality -- A Handbook for PQRI Participation" under the "Educational Resources" link on the PQRI Web site or at www.cms.hhs.gov/PQRI/Downloads/PQRI_Coding_for_Quality_Handbook_061807.pdf.

PQRI tracks CT or MRI brain studies performed within 24 hours of hospital arrival for ischemic stroke, transient ischemic attack (TIA), or intracranial hemorrhage patients 18 years of age or older. The report must document presence or absence of hemorrhage, mass lesion and acute infarction. Clinicians who provide the diagnostic imaging study professional component in the hospital or outpatient setting will submit this measure each time they perform a CT or MRI in these settings for qualifying patients.

Qualifying CPT procedure codes: 0042T, 70450, 70460, 70470, 70551, 70552, 70553

Qualifying ICD-9 codes: 431, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, 435.0, 435.1, 435.2, 435.3, 435.8, 435.9

PQRI codes: If you have hemorrhage, mass lesion and acute infarction presence or absence documentation, report CPT II codes 3110F (Presence or absence of hemorrhage and mass lesion and acute infarction documented in final CT or MRI report) and 3111F (CT or MRI of the brain performed within 24 hours of arrival to the hospital)

OR

• If the patient does not qualify because the brain CT or MRI was performed more than 24 hours after arrival to the hospital, report 3112F (CT or MRI of the brain performed greater than 24 hours after arrival to the hospital)

OR

• If you don't have hemorrhage, mass lesion and acute infarction presence or absence documentation without a specified reason, report 3111F and modifier 8P (Presence or absence of hemorrhage and mass lesion and acute infarction was not documented in final CT or MRI report, reason not otherwise specified).

Report this measure each time the provider performs a carotid imaging study (neck MR angiography [MRA], neck CT angiography [CTA], neck duplex ultrasound, carotid angiogram) for ischemic stroke or TIA patients 18 years of age and older. Reports must include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement. Clinicians who provide the diagnostic imaging professional component in the hospital or outpatient setting for stroke or TIA patients will submit this measure.

Qualifying CPT procedure codes: 70498, 70547, 70548, 70549, 75660, 75662, 75665, 75671, 75676, 75680, 93880, 93882

Qualifying ICD-9 codes: 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, 435.0, 435.1, 435.2, 435.3, 435.8, 435.9

PQRI codes: If documentation references distal internal carotid diameter as the denominator for stenosis measurement, report 3100F (Carotid image study report includes direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement)

OR

• If the provider doesn't reference the measurements for medical reasons, report 3100F and modifier 1P (Documentation of medical reason[s] for not including direct or indirect reference to measurements of distal internal carotid diameter)

OR

• If you don't have a specified reason for no reference to the measurements, report 3100F and modifier 8P (Carotid image study report did not include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement, reason not otherwise specified).