Physician Quality Reporting System for Anesthesia

Overcome your PQRS reporting challenges with these expert healthcare training tips provided by our expert in a healthcare coding conference.

The numerator:
The numerator is the G-code which we don't really have any G-codes because that's a group designation code. And our measures are reported in those category 2 medical codes.

The denominator: It is that ASA or CPT code that you're going to be reporting; your ASA CPT codes that you report, your 400, 840 – all of your ASA codes for number 30 and number 193, and that's the blanket warming.

The CVP line
: It is a CPT code. And it's the Swan-Ganz catheter and all of the CV catheter codes. So if your practice reports any of those CV codes or the Swan, that's going to be included in your calculations.

Anesthesia doesn't have any commonly reported ICD 9 codes. We have all kinds of ICD 9 codes and it could be any ICD-9 code. So your basic qualifiers are going to be your ASA codes because those ICD 9 codes with anesthesia, they're not necessarily confined to the ASA codes.

Now, we'll look to see if the measures group applies. You want to look to see if your patient has that required CPT code or your ASA code on the claims. Are they the listed age range? And then, does the individual measure apply?

If that patient fits into the group but the measure doesn't apply because of the age or the gender or the diagnosis, then you cannot report it or you can do an exclusion. There are exclusions.

If you're in the habit and you get in the habit of reporting, it would better ensure success in getting the bonus rather you would be safe instead of sorry. And you would get in the habit you think of reporting all of the Medicare cases.

But again, what you need to do is your group needs to set up procedures and policies based on the applicable measures that would apply to that practice and that would be the best for your group to report for success. Because that's what you want to do – you want to report these for success.

Correct Use of Modifiers: As far as the modifiers go, and the modifiers have been very confusing. There are only two that apply to the anesthesia really.

The modifiers would be telling the government why we didn't do this. That one P means that it was due to a medical reason. Now, that medical reason can be any reason. It's not indicated. There was a contraindication or as we'll see as when get to the blanket warming, there's a couple of other exclusions as per Medicare guidelines.

One of the things that we would hope not to see in the ASA and some of their literature have made it fairly well-known, “Action not performed; no reason specified.”

That's just like saying on your claims with your ICD-9 codes, “not specified”. Providers need to get in the habit of giving specific diagnosis and they have to have specific reasons for not reporting these measure codes.

Because these measure medical codes and this PQRS are not going to go away. And it's going to be something that eventually happens but it is definitely going to impact your money. It does already with the bonus but there may be the day, we've heard it time and again that it will impact the actual reimbursement.

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