April 2008 News

  

“PQRI Measures for Oncology & Hematology”  Physician Quality Reporting Initiative (PQRI) has already begun for 2008, and can affect your bottom line, so it is important to avoid the potential reporting pitfalls. An example of PQRI measures that apply to oncology and hematology are listed below: ·         67 – Baseline cytogenic, testing performed on home bone marrow ·         68 – Documentation of iron stores in patients receiving erythropoietin therapy ·         69 – Treatment with biophosphonates ·         Baseline flow cytometry ·         71 – Hormonal therapy for Stage IC-III breast cancer ·         72 – Chemotherapy for Stage III colon cancer patients ·         73 – Plan for chemotherapy documented before chemotherapy administered ·         103 – Review of treatment options in patients with clinically localized prostate       cancer You only have to report on three measures per claim at least 80% of the time when that measure applies to any patient seen by a physician. If there are four or more applicable measures, you have to meet the 80% threshold on at least three of the measures being reported. Remember that all PQRI claims must be reported with the provider’s NPI number. It is also important to code the appropriate modifiers with PQRI Category II codes, not with G codes. Modifiers can vary depending on which measure you are coding for, and there will be situations when a modifier is appropriate to the Category II code to explain why a measure could not be completed. ·         1P- Exclusion modifier due to medical reasons ·         2P- Exclusion modifier due to patient reasons ·         3P- Exclusion modifier due to system reasons ·         8P- Reporting modifier, action not performed, reason not otherwise specified.  Using this modifier indicates that the physician is not taking credit for that service. Always use the appropriate ICD-9 and CPT codes. For additional information, the PQRI coding handbook is online at: www.cms.hhs.gov/PQRI/Downloads/2008 PQRICodingforQualityHandbook.pdf        If you need any additional information on this article or Coding & Compliance services please contact Cindy Tipton at Cindy_Tipton@MED3000.com For a printable version, click:  CCNewsletterApril2008 Click here, if you would like to subscribe to this monthly MED3OOO e-communication newsletter.    ©Copyright 2008. MED3000 Group, Inc. All Rights Reserved