PQRI for physical therapists and occupational therapists

Beginning in 2009, physical therapists or occupational therapists who report on quality measures will receive a 2% bonus. The reporting period for 2009 is January 1 - December 31, 2009.

With CPT codes 97001-97546, physical and occupational therapists could report the following individual PQRI measures:

#114. Inquiry regarding tobacco use (CPT 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_114_09.pdf

#124. Adoption/use of electronic health records (EHR) (CPT 97001,
97002 (physical therapy evaluation),
and 97003, 97004 (occupational therapy evaluation))
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_124_09.pdf

#126. Diabetic foot and ankle care, peripheral neuropathy:
neurological evaluation (CPT 97001, 97002 (physical therapy
evaluation))
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_126_09.pdf

#127. Diabetic foot and ankle care, ulcer prevention: evaluation of
footwear (CPT 97001, 97002 (physical therapy evaluation))
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_127_09.pdf

#128. Body mass index (BMI) screening and follow-up (CPT 97001,97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_128_09.pdf

#130. Documentation and verification of current medications in the
medical record (CPT 97001, 97002, 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_130_09.pdf

#131. Pain assessment prior to initiation of patient therapy and
follow-up (CPT 97001, 97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_131_09.pdf

#134. Screening for clinical depression and follow-up plan (CPT 97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_134_09.pdf

#154. Falls - Risk assessment (CPT 97001, 97002, 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_154_09.pdf

#173. Unhealthy alcohol use - screening (CPT 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_173_09.pdf

#181. Elder maltreatment screen and follow-up plan (CPT 97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_181_09.pdf


"We have not recorded BMI or done a Fall assessment on a regular basis. Is there an opportunity to go back and check our documentation for this item and report that, even if this is an omission, and report forward in 2009?"

Yes - with a registry like MDinteractive you can go back and report
old PQRI 2009 data and then report forward.

Also please be aware that there is no performance requirement with
PQRI. Your providers will get 2% bonus just for reporting data. For
example if when you go back and check the BMI you find out that the
BMI was not calculated or that BMI (≥ 30 or < style="font-weight: bold;">

"How many patients need to be reported and what population to qualify
for your registry requirements?"

You need to report 3 individual PQRI measures to be eligible for the 2% bonus.
On each individual PQRI measure, you will need to report at least on
80% of Medicare patients on which that measure applies.

For example, for the BMI measure (#128) you would need to report on at
least 80% of your 2009 Medicare patients aged 18 years and older on
date of of visit with CPT 97001 and 97003.

"We have an EHR, however, within physical therapy we do not record the medications and laboratory so it's my understanding we do not meet the guidelines."

You only qualify for the EHR measure if:
- You have 97001, 97002 (physical therapy evaluation) and 97003, 97004
(occupational therapy evaluation) CPT codes.
- You are using CCHIT-certified EMR or, if not CCHIT certified, the
system must be capable of all of the following:
1) Ability to manage a medication list
2) Ability to manage a problem list
3) Ability to manually enter or electronically receive, store and
display laboratory results as discrete searchable data elements
4) Ability to meet basic privacy and security elements

Becoming a Medicare Qualified PQRI Patient Registry

This will be the first of a series of posts describing MDinteractive's experience of becoming a Medicare Qualified PQRI Registry.

General Introduction

To improve quality of the healthcare in the US, Medicare has a innovative program called Physician Quality Reporting Initiative that rewards physicians for reporting quality measures like checking cholesterol levels on diabetics patients, doing mammograms, giving smoke cessation advice, etc.

This is part of a movement to slowly change the way the system rewards physicians - right now with a fee-for-service payment system, healthcare professionals are paid more for "doing things" to patients and not for keeping patients healthy.

With the PQRI incentive program, physicians can earn an incentive payment of 2% above the regular Medicare Physician Fee charges.

The 153 PQRI Quality measures can be found here:
http://www.cms.hhs.gov/PQRI

Examples of PQRI Measures:



How to Report PQRI

There are basically two main options to report PQRI options:

- Claims Based Reporting
- Registry Reporting

Claims-Based Reporting:

In this case, a physician will need to report at least 3 PQRI Quality Measures for at least 80% of applicable patients.

For example, a pulmonary specialist would report 3 measures from all Medicare patients seen with the diagnosis of community acquired pneumonia(measures 56, 57 and 58).

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

When the doctor treats someone with the diagnosis of pneumonia (ICD-9 code 481), and a CPT code for a office visit like 99204 then she/he will also add the CPT II code 2010F in the same CMS-1500 billing form. This code means that vital signs like temperature, pulse, respiratory rate, and blood pressure were documented and reviewed.

The worksheet for these measures can be seen at the AMA website:
Participation Tools: Individual Quality Measures for 2009 PQRI and more specifically here for measure #56

On the same CMS-1500 claim form he also enter quality codes for measures #57 (Assessment of oxygen saturation - code 3028F) and for measure #58 (Assessment of mental status - code 2014F).

Each one of the quality codes must be submitted with a line-item charge of $0.00. Charge field cannot be left blank.

At the end of the year, if the above pulmonary specialist saw 10 Medicare patients with community-acquired pneumonia and reported measures #56, #57 and #58 on at least 8 of those patients will receive a 2% bonus over all her/his Yearly Medicare Part B Fee-for-Service revenues.

We should note that the 2% applies to all the Medicare Part B fees charged for all the Medicare patients seen by the doctor and not only to the patients with community-acquired pneumonia. For example if the the yearly revenues were $100000, the bonus would be $2000.

In the next post, we will describe an Alternative Reporting Method using a Qualified Medicare Registry like MDinteractive.