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Thread: PQRI Measure #43

  1. #1
    Join Date
    Apr 2007
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    Kansas City, MO
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    Default PQRI Measure #43

    Measure #43: Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) in Patients with Isolated CABG Surgery

    I am needing to know if anyone knows what CMS means when they say "Isolated CABG". In our practice we use this phrase when no other procedures are performed during the CABG. But I am wondering if this is what CMS's means. I am needing to instruct our staff on when to report this measure. Some believe that we should report this for every CABG done and others belive it should only be reported when the only procedure done during that session is a CABG.

    Can anyone help?

    Thanks!

  2. #2
    Join Date
    Apr 2007
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    1,716

    Default

    I have no idea if this is right or not but here goes..

    http://www.cms.hhs.gov/HospitalQuali...rCal200512.pdf

    I am researching PQRI for our cardiovascularthoracic surgery group and I ran across this. It looks to me like isolated means it is the listed as the first procedure, but this is very confusing and doesn't really make sense to me.

    If anyone has more information or more clear information I would greatly appreciate it.

    Thanks

    Laura, CPC

  3. #3
    Join Date
    Apr 2007
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    12

    Default Interpretation of Measure 43

    You are reading way too much into this measure and what does Medicare mean by "Isolated CABG". All of the measures follow the same general guidelines and same game plan.

    # 1) Does the patient have Medicare
    # 2) Is the patient's age and/or sex appropriate for the measure
    # 3) Did we perform a CPT code that was appropriate for this measure
    (can be listed anywhere on the claim)
    # 4) Did we enter a specific diagnosis (when needed) for this encounter

    For measure # 43, you need to have a Medicare patient over age 18 for which you are performing and documenting at least one of these CPT codes, 33510, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, or 33536. This particular measure does not have a diagnosis code requirment.

    It is just this simple, nothing more.

    Hope this helps,
    Tom Beach, BS, CPC, PCS
    beach002@mc.duke.edu

  4. #4

    Default

    This measure is only to be used if a CABG is the only procedure the patient had (aka: an isolated CABG). So Tom is not completely correct, if a CABG is done in addition to say, an AVR, you will not report this measure.

    Lisi, CPC

    Here is a link to the measure descriptors on the CMS website

    http://www.cms.hhs.gov/PQRI/15_Measu....asp#TopOfPage

  5. #5
    Join Date
    Apr 2007
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    12

    Default PQRI Measure # 43

    Lisi,

    I respectfully choose to disagree with your assessment. Measure # 43 refers to CABG's, not Aortic Valve Replacements. I would draw your attention back to the CPT codes which trigger measure # 43. Nowhere do those CPT codes refer to AVR's 33405, 33406, 33410, 33411 or 33412. The PQRI codes that trigger for these CPT's can be found in Measures 20, 21 and 45. For some reason (and I'm sure this was an oversight by CMS), they have left out CPT 33412 as triggering PQRI. I am certain they will probably add it to the 2010 measure specs when someone from the AMA alerts them to this omission.

    But the CABG codes trigger way more measures than # 43. In fact the above CABG codes I mentioned that are in the specifications for measure #43 also trigger measures 20, 21, 44 and 45.

    So in your scenario of a patient having an AVR, say 33411 and then two arterial bypass grafts 33534, CMS is going to expect you to answer measures 20, 21, 43, 44 and 45. Missing any one of these measures will set the provider up for failure. The CPT codes on the claim can be listed in any line item on the claim. While measures 20, 21 and 45 trigger for both 33411 and 33534, they only need to be answered one time.

    I hope this helps you understand this more clearly. There is a Surgical CPT look up tool that can be found at the American College of Surgeons website at www.facs.org/ahp/pqri

    I can't tell you exactly which download you need to look at as I am on my home computer with a crappy connection speed and I can't seem to bring it up, so you'll need to do some digging. We found this in 2007 and have been adding and subtracting as Medicare changes the codes from year to year.

    Thank you,
    Tom Beach, BS, CPC, PCS

  6. #6
    Join Date
    Apr 2007
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    1,716

    Default

    I have done more research and I continue to find that "isolated CABG" means this is the only major cardiac procedure done at that time. There are several studies about using beta blockers prior to isolated CABGs, which they define as stated above, so there has to be a difference otherwise why would they use the term isolated?

    I don't think 33412 was an oversight at all. I would suggest you email the contact at CMS for further clarification. I emailed them before and a physician at CMS responded to me very promptly.

    I am fortunate in that we are using the STS to report for us and I don't have to know too much about PQRI for my CVT providers.

    Laura, CPC, CEMC

  7. #7

    Default

    Hi Tom,

    I respectfully choose to disagree with you I understand that the CABG codes will trigger measures 20, 21, 43, 44 and 45. However, you only report on measures 43 and 44 if the only procedure performed is a CABG.

    So, in the example you gave (a patient having an AVR, say 33411 and then two arterial bypass grafts 33534, CMS is going to expect you to answer measures 20, 21, 43, 44 and 45), CMS is not expecting you to answer 43 and 44 because an isolated CABG was not done.

    I've been reporting these measures for my physicians since PQRI started and I reviewed the report sent back from the 1st reporting period. We were never penalized for missing measures 43 & 44 when a CABG was performed with another procedure and all of my physicians received the bonus payment. I'm confident I am doing this correctly.

    Thanks!
    Lisi, CPC
    eharkler@nmh.org

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