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Pqri

  1. #1
    Default Pqri
    Medical Coding Books
    Can PQRI codes only be billed once a year or can they be billed at every encounter? I have some doctors stating only once and some doctors say at every encounter. Please help Thanks

  2. #2
    Location
    Everett, Washington (20622)
    Posts
    27
    Default PQRI Reporting
    My understanding is that it will depend on the measure you are reporting and how you are reporting. Some measures are only performed once a year so should only be reported once a year for each patient that receives service. If you are reporting PQRI Measures on a claim it should be done at the tiem of billing following the measure reporting requirements.
    If you are using a registry or an EHR there may be possible to do it after the services are performed. Here is a link I found helpful.

    http://www1.cms.gov/PQRI/Downloads/2...tFS032310f.pdf

  3. Default Pqri
    You only have to report on a given measure once per patient to Medicare for either the 30 consecutive patients or if you're doing the 80% reporting.

  4. #4
    Question PQRI newbie Help!
    My organization would like to start reporting PQRI. My question is if a patient comes in for knee pain, new or established, if they happen to have diabetes and they are not having any trouble with it, and or not there for a check for it do you automatically do the pqri without them having an issue with it just so you can get the measure?

  5. #5
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by stacy pauley View Post
    My organization would like to start reporting PQRI. My question is if a patient comes in for knee pain, new or established, if they happen to have diabetes and they are not having any trouble with it, and or not there for a check for it do you automatically do the pqri without them having an issue with it just so you can get the measure?
    I work for an organization with many specialty clinics (and one primary care); they choose which PQRI measures to report based on what type of clinic they are. For example, the Internal Med clinic reports the preventive measures; endocrinology reports the diabetic measures; rheumatology reports the rheumatoid arthritis measures. So, if a patient with knee pain reports to their PCP in IM, they would still do the preventive - even if the patient is diabetic. However, if that same patient went to endocrinology, they would report the diabetic measures. When a clinic/doctor chooses which measures to do, they do the same one on all qualifying patients. The CMS website has a lot of excellent information on PQRI.

    I hope this helps.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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