tci Medicare Compliance & Reimbursement - 2008 Issue 14
Coding Coach: Append Modifiers When Measure Isn't Met
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Article Overview
This article covers Physician Quality Reporting Initiative (PQRI) reporting when a patient encounter qualifies but the measured action is not completed. It is intended for coders and billing staff who support quality reporting and want a general understanding of the modifier categories used to explain why a measure was not met.
Why This Topic Matters
Accurate quality reporting affects whether encounters are counted correctly for PQRI participation and helps practices document why a measure was not performed without losing credit for the visit.
What You Will Learn
- How PQRI encounters are reported when a quality measure is not performed
- The general categories of modifiers used in PQRI reporting
- Why documentation of the reason for a missed measure matters for reporting
- How quality reporting supports practice-level participation tracking
Who Should Read This
- Medical coders
- Billing staff
- Quality reporting personnel
- Physician practice administrators
Modifiers Discussed
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