E/M Coding Alert - 2009 Issue 3
Participate in PQRI to Share in Increased Bonus Payment
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Article Overview
This article covers a Medicare quality-reporting topic for emergency department clinicians, coders, and billing staff. It explains the general purpose of the Physician Quality Reporting Initiative, the role of CPT Category II quality-data reporting, and the use of modifiers when a measure is not fully met. The article also walks through emergency department examples involving diagnosis and evaluation-and-management coding alongside PQRI reporting requirements.
Why This Topic Matters
Practices that report quality measures correctly may be eligible for incentive payments, so coders and billing teams need to understand the reporting structure and documentation requirements. The article is relevant for avoiding incomplete quality reporting and for aligning routine claim coding with Medicare quality initiatives.
Article Sections
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PQRI participation basics
Introduces the quality-reporting program and explains its role in Medicare incentive reporting. It outlines the general reporting framework and the type of measures involved.
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Choosing measures your ED sees often
Discusses selecting reporting measures that fit emergency department practice patterns. It also describes the general relationship between claim coding, measure selection, and quality-data reporting.
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Example of reporting a measure met
Provides a clinical example illustrating how a reported encounter can align with a quality measure. The section shows the overall structure of claim reporting for the encounter.
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Use P modifiers when measure isn't met
Explains the general use of modifiers when a quality measure is not fully satisfied during a visit. It includes an emergency department example showing how the reporting concept is applied.
What You Will Learn
- How PQRI participation fits into Medicare quality reporting
- How CPT Category II quality-data reporting is used in the program
- How emergency department measures are selected and reported at a high level
- When modifiers are used to indicate a measure was not fully met
- How quality reporting is coordinated with routine claim coding in emergency care settings
Who Should Read This
- Emergency department physicians
- Medical coders
- Billing staff
- Practice managers
- Quality reporting personnel
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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