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Thread: PQRI for Anesthesia group

  1. #1

    Unhappy PQRI for Anesthesia group

    AAPC: Back to School
    As far as pre op antibiotics by the anesthesia team; I have researched, read and listened to all of the info that I could possibly find, yet when I reported it on over 6,000 patients in 2009. I got denied on every one???????
    (only Medicare patients, all with proper documentation)

    Should we be putting the 4047F AND the 4048F on every claim? (that applies)
    4047F and 4048F 8P if ordered and not given
    4047F and 4048F if ordered and given
    If not ordered at all, we dont report either code?
    so a 4047F would never be used alone?
    what about the 1P ?

    I dont know what I am doing wrong and I cant seem to get any straight forward answers from anyone at Medicare or anywhere else.....

    Can I hear from an Anesthesia practice that actually got paid for this?

    Thanks so much,

  2. #2


    4047F - 8P not ordered
    4048F ordered and given timely
    4048F - 8P ordered but not given timely
    4048F - 1P ordered but not given for medical reasons

    These are what we bill, are you billing them with an amount? We bill them out at zero, and then at a time specified by CMS they send out checks if you meet 80 % or I think it's 20 consecutive cases. Also, are you billing other PQRI performance measure which are not being met 80%? If so my understanding is that CMS takes all performance measures as one lump and if the other such as MSBT (maximum sterile barrier technique) 6030F isn't met it could affect your totals and keep you from getting paid.

  3. #3

    Default anes pqri

    Hi, thank you for your response,
    We are billing zero $ and this is the only measure we are reporting thus far.
    We billed many, many 4048Fs for ordered and given in a timely fashion but our PQRI report that we retreived has what looks like everything denied.
    We did this for all of 2008 so we would have received reimbursement in late 2009, correct?
    We also did it this way for all of 2009 but it would be too early to see those results.
    Do you know how to pull the PQRI report on line to see the progress up until now? It didnt work for me.

    Was I supposed to be reporting both 4047F AND 4048F on each claim for ordered and given?
    Last edited by sandraboty; 01-14-2010 at 01:38 PM.

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