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Thread: PQRI with ED

  1. #1
    Join Date
    Apr 2007
    atlanta GA

    Default PQRI with ED

    AAPC: Back to School
    Hi Everyone,
    I expecting some help regarding how to code PQRI with ED. Greatly appreciated any help.

  2. #2
    Join Date
    Apr 2007
    North Seattle


    Quote Originally Posted by drspatil View Post
    Hi Everyone,
    I expecting some help regarding how to code PQRI with ED. Greatly appreciated any help.
    The ACEP.org website has general information about PQRI.
    Here is the link: http://www.acep.org/practres.aspx?id=32148

    Hopefully you can find something here to help.
    claudia salas

  3. #3


    Hi Doctor!

    Hope this web site helps you. http://www.cms.hhs.gov/PQRI/02_Spotlight.asp#TopOfPage

  4. #4
    Join Date
    Apr 2007

    Default PQRI and ED Services

    Dr. Sanjay,

    First, I would work with your IT people to make sure they can program your billing system to accept/allow a zero $ charge on a claim for ED services. You will need to enter the PQRI code information exactly like an ED charge, i.e., date of service, place of service, type of service, CPT (the Category II code), modifier if appropriate, diagnosis pointer, charge amount - should be $0.00, NPI.

    I would point you to a huge PDF file (442 pages) of measure specifications. Go to this site
    Scroll down to the downloads and click on the fourth one down called 2009 PQRI Measure Specifications Manual.
    The measures you are going to be looking at are 28, 54, 55, 56, 57, 58 and 59. You need to read through these measures fully to understand what you are required to do and how to answer the measures. Each of these measures relates to patients who have Medicare, are over age 18, came to the ED for an Evaluation and had a specific diagnosis code. All of the elements must line up like the stars for you to be able to answer the PQRI measure.

    Your next step is to discuss with your billing department and/or finance department how to measure your success vs. failures. CMS will not give you your results until 10 or 11 months after the end of the year. So you are going to have to develop your own means test and monitor your progress all year long. If you don't, you will be completely in the dark and may have a very rude awakening down the road. While failures are bad, they will help you focus on what went wrong and what can you do to become better.

    You will also want to have someone check your Medicare 836 file to make sure you are receiving credit for the measures you are submitting. For instance, if you answered measure 54 that you did a 12-lead EKG for a patient on arrival who was having a non traumatic chest pain diagnosis, you would submit the category II code 3120F. If you also submit this code successfully with CPT 99284 (assuming your documentation supports this level of care) and diagnosis code 786.50 as an example, then someone will need to go and look at your Medicare EOB/RA - (the payment) and make sure that the line with the 3120F has an "N365" code on the RA. This is Medicare's acknowledgment that they received your quality measure and you got credit for it.

    What you want to do is make sure that you answer at least 3 of these measures at least 80% of the time per provider when they are applicable. The PQRI bonus is based on individual NPI under a Federal TIN.

    Thank you,
    Tom Beach, BS, CPC, PCS

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