Outpatient Facility Coding Alert - 2008 Issue 12
Append Modifiers When Measure Isn't Met
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Article Overview
This article covers Physician Quality Reporting Initiative (PQRI) reporting when a required quality measure is not performed during an otherwise reportable encounter. It explains the role of category II codes and the broader modifier framework used to indicate why a measure was not met, making it relevant to coders, billing staff, and quality-reporting teams working with Medicare participation requirements.
Why This Topic Matters
Accurate PQRI reporting affects how encounters are counted in quality initiatives, so understanding the reporting structure helps practices document encounters consistently and avoid incomplete measure submission.
What You Will Learn
- How PQRI encounters are reported when a quality measure is not performed
- Why category II codes are part of quality reporting
- The general purposes of the modifier framework used in PQRI reporting
- How Medicare counts these encounters toward PQRI totals
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Quality reporting personnel
- Physician practice administrators
Modifiers Discussed
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