PQRS Measures: Know How to Properly Collect and Submit Quality Data


We have the PQRS measures, earlier known as the PQRI measures, the quality measures, keep growing every year. So what they're measuring for quality keeps growing every year. There are contributing factors to consider before selecting your quality measure. There are individual measures or measures group.

There are reporting methods. You can use claim-based, which means you report your quality measures with your claim when it happens. There's a registry which means you report it after the fact and you can actually report it all the way into February of the next year. You can report it with your electronic health record if you have one. You can report it in this group practice methodology that they selected for both smaller group practices and large group practices. You also have to determine your reporting period, whether you're going to do a six or 12-month reporting period.

So what are PQRS measures? An example of a measure is the percentage of patients regardless of age who undergo central venous catheter insertion for example, all elements that have maximal sterile barrier technique including cap, mask, sterile gown, sterile gloves, large sterile sheet, hand hygiene and chlorhexidine.

So that's an example for a central vein catheter that you want to report the sterile method that you're using on that patient.

So what you have is you have associated denominator which defines the eligible patient population and that can be any of the ICD 9 codes, a CPT or HCPCS level 2 code. Other patient criteria such as age of the patient and the place of service of the encounter can also be identified.

So for example, patient age such as greater than 60 years old at the date of encounter or a diagnosis of syncope could be part of the denominator. Or the patient encounter during the reporting period has to be emergency room procedures or critical care such as CPT codes 99281 to 99285 or 99291. Or, it could be that the place of service encounter has to be 23 which is the emergency department.

So basically, the denominator gives us the criteria that have to exist for the measure to apply to that patient. So for example, measure group asthma which is a new measures group for 2011, has a denominator criteria that the patient has to be between ages five and 50. So that's the denominator in that measures group.

Then you've got associated quality data medical codes. And that's what's used to report the quality action taken. They're called the numerators. And this code can either be a CPT category 2 code or HCPCS level 2 G-code.

For example, G8455 is a current tobacco smoker. G8456 is a current smoke-less tobacco user. G89457 is a current tobacco non-user. Whereas, a category 2 code of 4000F is a tobacco use cessation intervention counseling. And 4001F is tobacco use cessation intervention pharmacological therapy which means they're using a drug like Chantix.

There also can be modifiers to indicate specific reasons why quality PQRS measures may not have been performed. For example, 1P is performed due to medical reasons, 2P is due to patient reasons, 3P is due to system reasons and 8P is reason not specified.

Get a wide range of PQRS and medical billing and coding training events that help you run your organization profitably; visit AudioEducator.

Our Accreditation Partners
Facebook Twitter Linkedin Youtube RSS Feeds Google Plus