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PQRS/Need Expert-level assistance

maddismom

Guru
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180
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We are a family practice and are going to begin reporting PQRS; as I'm no longer doing hospitalist coding and PQRS reporting (with hospital E/M only), I have some questions.

Specifically, if an E/M or procedure code is NOT listed under the Denominator, can the measure still be reported? For Measure 113, G0438 and G0439 are not listed, so if that is the care the patient received, I am unable to report the Measure for that patient that day, correct? And Measure 134 is for depression, but if patient also received G0444 for annual depression screening, I would not report Measure 134 because G0444 is not listed under the Denominator?

The last question is the one that really throws me and has to do with 90658/Q-codes. Medicare removed 90658 from Measure 110 under the Denominator, but did not add the Q codes under the Denominator. Therefore, I am unable to report Measure 110 if flu Q code was received (even though I have an office visit code to report also)?

I know I'm over-thinking all of this...just want it right when I give the info to management....

Thanks in advance!
 

cblack712

Guest
Messages
109
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PLEASE PLEASE PLEASE - Don't take this personal, but don't read into PQRS too much. Do as it says to a "T"....
If the CPT isn't in the denominator field than don't apply the measure to that CPT, even if the CPT is for an equivalent code that may be in the denominator field. I do see where you are going with the questions, but my suggestion would be to go to CMS and print out a copy of the PQRS worksheets, they walk you through step by step in determining whether to apply a measure or not. What CMS has in the numerator / denominator fields is all that they want quality measures reported on. As time goes on, they will more than likely add to it.

Don't stress yourself on the 90658/Q-codes - CMS had a reason for removing it. -- Rumor has it that it wasn't reported enough as it was....

Also, make sure you are reporting on CPT codes and not per visit. One CPT may be on the list and another not, you will still bill the qualifying measure with the qualifying CPT code.

Another good place that will answer some of your questions (and allows you to print the response so that you can give something reputable to your sups) is https://questions.cms.gov/ look under the tab to the very left of the page where it says "incentives"
 

06Coder

Contributor
Messages
18
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0
I do not work with PQRI/PQRS reporting, but was asked if there are measures for providers to report activity outside of the patient visit? For example, the exact question asked was if the provider can report for the review of records/tests with summary and documentation in patient's record? If so, can you provide a link to were this info may be referenced? Thanks in advance.
 
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