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

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

PQRI Measures for Radiologists

There are several individual PQRI measures that apply for radiologists:

#10 - Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports

Measure description
Percentage of final reports for CT or MRI studies of the brain
performed within 24 hours of arrival to the hospital for patients
aged 18 years and older with either a diagnosis of ischemic
stroke or transient ischemic attack (TIA) or intracranial
hemorrhage or at least one documented symptom consistent
with ischemic stroke or TIA or intracranial hemorrhage that
include documentation of the presence or absence of each of the
following: hemorrhage and mass lesion and acute infarction
AMA Data Collection Form
AMA Coding specifications

#11 - Stroke and Stroke Rehabilitation: Carotid Imaging Reports

Measure description
Percentage of final reports for carotid imaging studies (neck
MR angiography [MRA], neck CT angiography [CTA], neck
duplex ultrasound, carotid angiogram) performed for patients
aged 18 years and older with the diagnosis of ischemic stroke or
transient ischemic attack (TIA) that include direct or indirect
reference to measurements of distal internal carotid diameter
as the denominator for stenosis measurement1
AMA Data Collection Form
AMA Coding specifications

#145 - Radiology: Exposure Time Reported for Procedures Using Fluoroscopy

Measure description
Percentage of final reports for procedures using fluoroscopy that
include documentation of radiation exposure or exposure time
AMA Data Collection Form
AMA Coding specifications

#146 - Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Mammography Screening

Measure description
Percentage of final reports for screening mammograms that are
classified as “probably benign”
AMA Data Collection Form
AMA Coding specifications

147 - Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy

Measure description
Percentage of final reports for all patients, regardless of age,
undergoing bone scintigraphy that include physician
documentation of correlation with existing relevant imaging
studies (eg, x-ray, MRI, CT, etc.) that were performed
AMA Data Collection Form
AMA Coding specifications

To get the 2% PQRI bonus, a radiologist 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.

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. 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 radiologist 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

CMS releases PQRI reporting measures that affect radiologists