Outpatient Facility Coding Alert - 2009 Issue 4
Follow 3 Steps to Establish PQRI Protocol
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Article Overview
This article is a practical overview for emergency department coding and billing staff who need to understand Medicare's Physician Quality Reporting Initiative (PQRI). It covers where to find official CMS guidance, how to identify measures relevant to an ED setting, and the types of reporting requirements tied to an example measure. The discussion is aimed at helping readers determine whether the article applies to their workflow without replacing the full premium guidance.
Why This Topic Matters
PQRI participation depends on using the correct CMS resources and understanding measure-specific reporting requirements. For ED teams, the article highlights the kinds of program guidance and claim-level details that can affect whether a quality-reporting submission is accepted.
Article Sections
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Check CMS for PQRI Overview, Specifications
Introduces the official CMS PQRI resources and the general purpose of the program materials. It points readers to the types of reference information used to understand reporting requirements.
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Find Applicable Measures
Discusses how to identify measures that fit an emergency department's patient population and services. It references a set of measures described as relevant to many EDs.
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Know PQRI Requirements for Applicable Measures
Reviews the kinds of claim and diagnosis requirements associated with a sample PQRI measure. The section also includes an illustrative scenario showing how reporting elements may come together on a claim.
What You Will Learn
- Where to find official CMS PQRI program resources
- How to identify PQRI measures relevant to an emergency department
- What general reporting requirements may apply to a PQRI measure
- How an example ED encounter is discussed in the context of PQRI reporting
Who Should Read This
- Emergency department coders
- Emergency department billing staff
- Physician quality reporting staff
- Revenue cycle professionals
- CPC / CCS-P certified coders
Codes Discussed
Code Ranges Discussed
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