Medicare Compliance & Reimbursement - 2008 Issue 8
You Be the Coder: PQRI and P Modifiers
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Article Overview
This coding Q&A explains a Physician Quality Reporting Initiative (PQRI) scenario for an emergency department case and discusses how reporting is handled when a quality measure is affected by care provided before ED arrival. It is useful for coders and compliance staff working with quality reporting, E/M services, and encounter-level reporting rules tied to ED documentation and measure submission.
Why This Topic Matters
It helps readers understand the relationship between PQRI measure reporting, ED documentation, and modifier use in a common quality-reporting scenario. The article is relevant to those who need to determine whether a special modifier is required and how to reflect the encounter on the claim.
Article Sections
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Question
A coding question is posed about an emergency department quality-reporting scenario involving an acute myocardial infarction encounter and aspirin timing before or during ED care.
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Answer
The response explains the reporting approach for the scenario and identifies the general claim-reporting elements referenced in the discussion.
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P modifier reminder
A reminder section summarizes the general purpose of PQRI P modifiers and lists the broad categories of modifier types used when a measure is not met.
What You Will Learn
- How PQRI measure reporting is discussed in an emergency department setting
- How aspirin timing relates to a quality-reporting encounter
- When a P modifier may be considered in a reporting scenario
- How the article frames claim reporting for a critical care encounter with an AMI diagnosis
Who Should Read This
- Medical coders
- Emergency department billing staff
- Quality reporting staff
- Compliance professionals
- Physician practices
Codes Discussed
Modifiers Discussed
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