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PQRI Summary of Changes for 2008
Steve Rinehart
Coding Operations Manager
Medicare continues its Physician Quality Reporting Initiative (PQRI) in 2008 with a few changes.
Measure 28 (beta blocker for AMI measure) is being retired, and Measure 76 (prevention of CRBSI—Central Venous Insertion Protocol) is being added. The frequency of this new measure in the ED is less than .5% nationwide. LYNX Medical Systems offers our clients the option of adding this measure to their current list of PQRI measures that are coded. In order to code this quality measure, the documentation must state that a cap, mask, sterile gown, sterile gloves, and sterile drape were used along with hand hygiene with 2% chlorhexidine prep.
To capture all of these data elements, LYNX is revising the Central Line Insertion Note template for our E/Map clients. We suggest that other template users who want to report on this measure customize their templates to include all of these data elements in a checkbox format. For dictation clients that want LYNX to code this measure, we suggest a summary statement to capture the elements. It is possible to report this measure with the 1P modifier when the physician indicates there was a medical reason for not following the protocol or with the 8P modifier when it was not met and the reason is not documented.
The most frequently coded PQRI measure is the Advanced Care Plan for all patients aged 65 and older. This measure continues in 2008 and is likely to have a greater financial impact for providers than the new measure mentioned above. The documentation required for this measure should state one of the following:
"advanced care plan discussed with patient and the advanced care plan and/or surrogate decision maker is in the medical record (CPT code 1123F)"
or
"advanced care plan discussed and patient did not wish or was unable to name a surrogate decision maker or provide an advanced care plan (CPT code 1124F)."
When the measure was not met and no reason was documented, LYNX will code it with an 8P modifier (CPT code 1123F -8P). Medicare intends to improve compliance by tracking these measures, so we encourage providers to work with their front desk staff to make sure that all patients over 65 are being asked for an advanced care plan and/or surrogate decision maker and that the documentation of their responses is added to the charts. This documentation was frequently absent in 2007, which means there is an opportunity for significant improvement in 2008.
Medicare has not announced any changes in the amount of bonus payments for 2008. The current structure consists of 1.5% of Medicare-approved reimbursement for each participating provider that successfully reported on at least 3 PQRI measures for 80% or more of the eligible cases.
For a complete listing of the PQRI codes and related information for 2008, visit the CMS website at
http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage
If you have any questions, please contact your Coding Operations Manager.
The information contained herein is provided for informational and educational purposes only, and nothing contained herein should be construed as advice. All information contained herein is obtained by LYNX Medical Systems (LYNX) from sources believed by LYNX to be accurate and reliable. Because of the possibility of human and mechanical error as well as other factors, LYNX is not responsible for any errors or omissions. LYNX makes no representations and disclaims all expressed, implied, and statutory warranties of any kind to user and/or any third party including warranties as to accuracy, timeliness, completeness, merchantability or fitness for any particular purpose.