PQRI for Pulmonologists

There are several individual PQRI measures that apply for pulmonologists:

COPD Care

#51 - Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of COPD who had spirometry evaluation results documented
Data Collection Sheet
Coding Specifications

#52 - Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of COPD and who have an FEV1/FVC less than 70% and have
symptoms who were prescribed an inhaled bronchodilator
Data Collection Sheet
Coding Specifications

Asthma Care

#53 - Asthma: Pharmacologic Therapy
Measure description
Percentage of patients aged 5 through 40 years with a diagnosis
of mild, moderate, or severe persistent asthma who were
prescribed either the preferred long-term control medication
(inhaled corticosteroid) or an acceptable alternative treatment
Data Collection Sheet
Coding Specifications

#64 - Asthma: Asthma Assessment
Measure description
Percentage of patients aged 5 through 40 years with a diagnosis
of asthma who were evaluated during at least one office visit
within 12 months for the frequency (numeric) of daytime and
nocturnal asthma symptoms
Data Collection Sheet
Coding Specifications

Pneumonia Care

#56 - Community-Acquired Pneumonia (CAP): Vital Signs
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with vital signs
documented and reviewed
Data Collection Sheet
Coding Specifications

#57 - Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation
Measure description
Percentage of patients aged 18 years and older with a
diagnosis of community-acquired bacterial pneumonia
with oxygen saturation documented and reviewed
Data Collection Sheet
Coding Specifications

#58 - Community-Acquired Pneumonia (CAP): Assessment of Mental Status
Measure description
Percentage of patients aged 18 years and older with a
diagnosis of community-acquired bacterial pneumonia
with mental status assessed
Data Collection Sheet
Coding Specifications

#59 - Community-Acquired Pneumonia (CAP): Empiric Antibiotic
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with an appropriate
empiric antibiotic prescribed
Data Collection Sheet
Coding Specifications

To get the 2% PQRI bonus, a pulmonologist will need to report at least 3 of the measures above for at least 80% of the applicable Medicare patients seen during the year of 2009.

For reporting purposes, it is easier for a pulmonologist to choose the Community-Acquired Pneumonia measures because we need a set of 3 measures and the COPD and asthma sets only have 2 measures each. Technically you could pick one COPD measure, one Asthma measure and one Community-Acquired Pneumonia but then you will reporting on 3 different patient populations. With Community-Acquired Pneumonia, once you identified the patient population you can report 4 measures on each patient.

There are 2 main options to report the above measures.

1 - Add the appropriate quality codes regarding each measure to each billing claim you send to Medicare.
For example when using Community-Acquired Pneumonia add the following codes to your Medicare patients
2010F (#56 - Vital signs checked)
3028F (#57 - Oxygen saturation results documented and reviewed)
2014F (#58 - Mental status assessed)
4045F (#59 - Appropriate empiric antibiotic prescribed)

You just need to bill the same way as before but add
CPT 2010F, 3028F, 2014F and 4045F on section 24 of the billing form
and charge $0.00 or $0.01 for each code.

Example from 2009 PQRI Implementation Guide


However if you start reporting now using this method you may not be able to receive the full PQRI bonus because you already missed reporting more than half of your 2009 patients (you need to report at least 80%). So you should report PQRI using a qualified PQRI registry:

2 - Using a qualified PQRI registry like MDinteractive a pulmonologist may report 3 of the above PQRI measures and make your 2% bonus. For the complete list of 2009 PQRI qualified registries check the PQRI CMS website

For further info read:

2009 Measure-Applicability Validation Process for Claims-Based Participation

2009 PULMONARY PQRI PERFORMANCE MEASURES