Medicare Compliance & Reimbursement - 2007 Issue 21
PQRI: Don't Forget Modifiers For Measures That Don't Fit The Facts
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Article Overview
This short Q&A article addresses last-minute PQRI reporting questions for clinicians and coders. It focuses on how to think about reporting when an E/M visit is paired with a PQRI Category II code, how to handle visits with more than one applicable measure, and how timing-related quality measures may require additional modifier reporting. The discussion is aimed at coding staff, billing personnel, and clinicians working with PQRI-related claims, including anesthesiology-related measure reporting.
Why This Topic Matters
PQRI reporting can affect quality-measure submission accuracy and compliance, especially when the service scenario does not align neatly with the measure requirements. This article helps readers understand the general reporting issues involved so they can evaluate whether their claims and quality submissions need additional attention.
What You Will Learn
- How the article frames common PQRI reporting questions for claims involving E/M services and quality measures.
- How the article discusses situations where a visit has one or more applicable measures.
- How the article addresses timing-related PQRI measure reporting and the need to explain exceptions with modifiers.
- How anesthesiology is mentioned in relation to a specific PQRI measure.
Who Should Read This
- Medical coders
- Billing staff
- Quality reporting staff
- Clinicians submitting PQRI-related claims
- Anesthesiology practices
Codes Discussed
Modifiers Discussed
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