January 24, 2008
Anesthesia Business Consultants (ABC) has reviewed the PQRI (Physician Quality Reporting Initiative) measures for 2008. Contained within is information we hope will help guide your decision as to what measures you might want to report.
Measure #30, timely administration of antibiotic prophylaxis, remains the only measure specifically and exclusively intended for use in conjunction with anesthesia services. As before, physicians must generally submit data for at least three measures in order to qualify for the 1.5 percent Medicare bonus—but if there are only one or two measures that are applicable to the reporting physician’s individual practice, then reporting on that measure or those two measures in at least 80 percent of eligible cases for each will suffice.
Based on our review we have listed below those measures that may also apply to your individual practice, in addition to the antibiotic prophylaxis measure. Please note that Congress only passed the 2008 PQRI legislation on December 29th and that the Centers for Medicare and Medicaid Services (CMS) is still preparing basic information on participating.
Many anesthesia practices are planning to continue reporting the antibiotic prophylaxis measure and to begin reporting the new measure for “Prevention of Catheter-Related Bloodstream Infections (CRBSI) – Central Venous Catheter Insertion Protocol.” There are several other new measures that you may report together with one of 19 anesthesia services. What we cannot tell you for sure today is whether you must report one of these codes in order to submit data on the requisite minimum of three measures.
In 2007, CMS had in place a “Measure Applicability Validation” process containing a two-step test to determine whether a physician who reported only one or two PQRI measures should have selected any additional measure to report. The Agency is now updating that process for 2008. While we do not believe that the BMI and influenza counseling measures described below will become “applicable” in the sense that you are required to report them, we will not be able to give you definitive information until CMS clarifies this issue. The medication verification measure appears to us be applicable—and anesthesiologists typically ask patients about their medications already. Whether reporting the measure in 80 percent of eligible cases will be necessary in order to qualify for the PQRI bonus is unknown.
We apologize for the lack of clear guidance but we believe that you are entitled to the benefit of the information that is currently available. Please be assured that we will keep working to obtain and publish definitive answers soon.
1. NEW PQRI CODES APPLICABLE IN CONJUNCTION WITH ANESTHESIA SERVICES
The 2008 PQRI has introduced at least four new quality measures that you may select when submitting claims for anesthesia services to Medicare. Full descriptions, coding specifications and data collection worksheets for all the PQRI measures may be downloaded.
#130 - Universal Documentation and Verification of Current Medications in the Medical Record
This measure is reported when physicians can document that they verified current medications with dosages (includes prescription, over-the-counter, herbals and nutritional supplements) with patients aged 18 years and older (or that verification was not possible because of emergency, patient inability to participate, etc.)
It is to be reported with the following anesthesia codes (or with an E/M code):
00140, 00142 (anesthesia for procedures on eye),
00170 (anesthesia for intraoral procedures),
00400, 00402 (anesthesia for procedures on the integumentary
system on the extremities),
00810 (anesthesia for lower intestinal endoscopic procedures),
00832 (anesthesia for hernia repairs in lower abdomen),
00851 (anesthesia for intraperitoneal procedures in lower
abdomen including laparoscopy),
00910 (anesthesia for transurethral procedures),
00920 (anesthesia for procedures on male genitalia),
01380, 01382, 01400 (anesthesia for knee joint),
01732 (anesthesia for diagnostic arthroscopic procedures
of elbow joint),
01810 (anesthesia for all procedures on nerves, muscles,
tendons, fascia, and bursae of forearm, wrist, and hand),
01820 (anesthesia for all closed procedures on radius, ulna,
wrist, or hand bones),
01829 (anesthesia for diagnostic arthroscopic procedures
on the wrist)
#128 - Universal weight screening and follow-up
Use to report, for patients aged 65 years and older, whether a BMI was documented within the past six months and whether a follow-up plan was documented if the BMI was < 22 or ? 30. The weight screening PQRI codes may be reported together with the anesthesia codes listed above for Measure # 130 or with an E/M service.
#129 - Universal Influenza Vaccine Screening and Counseling
This general health measure may be reported with one of the anesthesia codes listed in Measures #128 and #130 support for patients over age 50 during the winter months – but if you report it once, you must then report it at each visit occurring during the months of January, February, March, October, November, and December during the reporting period for patients seen during the reporting period.
As with the other PQRI measures, you are also credited with reporting if you indicate that you did NOT perform the particular measure – the PQRI is about reporting, not about demonstrating performance improvement. You may, for example, report the PQRI code indicating that the patient’s BMI has been documented and is being managed by another physician.
#76 - Prevention of Catheter-Related Bloodstream Infections (CRBSI) – Central Venous Catheter Insertion Protocol
This measure may be reported for patients, regardless of age, who undergo central venous catheter (CVC) insertion with all elements of maximal sterile barrier technique followed. Report together with CPT Procedure code for catheter (CVC) insertion or replacement: 36555, 36556, 36557, 36558, 36560, 36561, 36563, 36565, 36566, 36568, 36569, 36570, 36571, 36578, 36580, 36581, 36582, 36583, 36584, 36585.
2. NEW CRITICAL CARE MEASURE
You are probably aware that a number of critical care interventions were under consideration for the 2008 PQRI set. In addition to the CRBSI measure (#76) discussed above, the final 2008 set includes the following:
#75 - Prevention of Ventilator-Associated Pneumonia (VAP) – Head Elevation
This measure may be reported for ICU patients aged 18 years and older who receive mechanical ventilation and who had an order on the first ventilator day for head of bed elevation (30-45 degrees). You can only report head of bed elevation together with the basic CPT® code for critical care, 99291.
3. PAIN MEDICINE
Pain medicine specialists who wish to participate in the PQRI but whose practices do not encompass the measures listed above – other than #128, the weight screening measure - may select from the following measures:
#114 – Inquiry Regarding Tobacco Use
Report for all patients aged 18 years and older who were queried about tobacco use one or more times within 24 months. Report together with an office visit code.
#115 – Advising Smokers to Quit
If you select this measure for reporting, you will report whether or not the patient smokes. If so, you will report whether you advised the patient to quit smoking, or not. Report with an office visit, outpatient consult or hospital observation CPT® code.
#109 – Patients with Osteoarthritis who have an Assessment of Their Pain and Function
Percentage of patients aged 21 years and older with a diagnosis of osteoarthritis (OA) with assessment for function and pain. This measure is to be reported each visit occurring during the reporting period for patients with osteoarthritis seen during the reporting period. This measure may be reported by clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
#124 - Adoption/use of Health Information Technology
There are probably not many pain physicians who will be ready to use this measure, which tracks whether or not the patient encounter was documented using a qualified Electronic Medical Record, i.e., one which is certified or which is capable of all of the following:
- Generating a medication list
- Generating a problem list
- Entering laboratory tests as discrete searchable data elements.
- The H.I.T. measure may be reported with an office visit or an outpatient consult for patients older than 18.
When ABC learns more about the “applicability” to anesthesiologists’ and pain physicians’ practices of these or other measures, we will contact you immediately. Meanwhile, anesthesiologists may be interested in ASA’s solicitation of member comments on the following five proposals for new PQRI measures (http://www.asahq.org/Washington/pqri.htm):
- Pencil-Point Spinal Needles – Reduction of Post-Dural-Puncture Headache
- Management of Postoperative Hypothermia
- Patient Education – Postoperative Analgesia
- Preoperative Fasting Status (Clear Liquids)
- Treatment of Postoperative Shivering with Meperidine
ABC hopes that the above information will be helpful to you.
