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October 2008

 
Savvy Coder: Coding & Reimbursement
PQRI 2009: CMS Fine-Tunes Its Pay-for-Performance Program
By Sue Vicchrilli, COT, OCS, Academy Coding Executive
 
 

Next year, the CMS’ Physician Quality Reporting Initiative will feature an increased bonus and three new quality measures.

The bonus incentive will increase from 1.5 to 2 percent. Furthermore, it will not have a cap. As in the past, this bonus is contingent on achieving 80 percent success for three quality measures (or fewer, if fewer apply). 

Three New Measures

Cataracts: Comprehensive Preoperative Assessment for Cataract Surgery With IOL Placement. Description: Percentage of patients aged 18 years and older who undergo cataract surgery with IOL placement and received a comprehensive preop assessment of 1) Dilated fundus exam; 2) Axial length, corneal keratometry measurement and method of IOL power calculation; and 3) Functional or medical indications(s) for surgery prior to the cataract surgery with IOL placement within 12 months prior to cataract surgery. Numerator/CPT II Code: Submit 0014F or, to indicate a nonspecified reason why the preop assessment wasn’t performed, 0014F–8P. CPT Codes: 66982, 66983 and 66984. ICD-9 Code: No diagnosis codes are associated with this measure.

AMD: Counseling on Antioxidant Supplement. Description: Percentage of patients aged 50 years and older with a diagnosis of AMD and/or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the Age-Related Eye Disease Study (AREDS) formulation for preventing progression of AMD. Numerator/CPT II Code: Submit 4177F; or, to report a system reason(s) why the counseling didn’t happen, 4177F-3P; or to report a nonspecified reason why it didn’t happen, 4177F-8P. CPT Codes: 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336 and 99337. ICD-9 Codes: 362.50, 362.51 and 362.52.

POAG: Reduction of IOP by 15 Percent or Documentation of a Plan of Care. Description: Percentage of patients aged 18 years and older with a diagnosis of POAG whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15 percent from the pre-intervention level) or if the most recent IOP was not reduced by at least 15 percent from the previous level, a plan of care was documented within 12 months. Numerator/CPT II Code: Submit 3284F to indicate the IOP is reduced greater than or equal to 15 percent from the pre-intervention level; or 0517F to document a plan of care plus 3285F to indicate the IOP is reduced less than 15 percent from pre-intervention level; or 0517F–3P to indicate there was a system reason(s) why a glaucoma plan of care was not documented plus 3285F (only append –3P to the first of those two codes); or 0517F–8P to indicate there was a nonspecified reason(s) why a glaucoma plan of care was not documented plus 3285F (only append –8P to the first of those two codes); or 3284F–8P to indicate there was a nonspecified reason(s) why IOP measurement was not documented. CPT Codes: 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336 and 99337. ICD-9 Codes: 365.01, 365.10, 365.11, 365.12 and 365.15.

To find out more, visit www.aao.org/pqri. Questions? E-mail pqri@aao.org.

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