E/M Coding Alert - 2009 Issue 6
READER QUESTIONS: Use P Mod on Non-Compliant PQRI Scenarios
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Article Overview
This reader Q&A discusses a Medicare emergency department case involving acute myocardial infarction, cardiopulmonary resuscitation, and physician quality reporting initiative (PQRI) measure reporting. It is aimed at coders and billing staff who need to understand the general documentation and reporting concepts involved when a quality measure is not satisfied for a clinical reason. The article also references the related diagnosis and procedure coding context and the use of a modifier to indicate why the measure was not met.
Why This Topic Matters
Articles like this help coding and compliance teams handle mixed clinical, procedural, and quality-reporting scenarios correctly on a claim. Understanding the reporting context can affect whether the encounter is documented in a way that supports both reimbursement and quality measure submission.
What You Will Learn
- How an emergency department encounter may be discussed in the context of PQRI reporting
- How CPR and evaluation-and-management services are considered in a single claim scenario
- How quality measure reporting can be affected when a clinical reason prevents a standard measure from being met
- How diagnosis coding is tied to the encounter context in the example
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Compliance staff
- Physician practice managers
- Quality reporting personnel
Codes Discussed
Modifiers Discussed
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