The Physician Quality Reporting System (PQRS) requires physicians and non-physician healthcare professionals who provide services to Medicare Part B beneficiaries to reporton quality improvement measures to avoid negative payment adjustments. In general, the quality measures calculate the percentage of eligible patients who receive a particular process of care or achieve a particular outcome.
The 2015 PQRS Clinical Quality Measures Infectious Diseases Reference (.xls) provides a listing of PQRS quality measures potentially applicable to ID specialists.
Each quality measure is defined by a numerator and a denominator. A measure's numerator, which consists of the quality data code (CPT Category II and/or G-codes), describes the clinical action required by the measure. A measure's denominator, which can be identified by a CPT Category I code, ICD-9 code(s), ICD-10 code(s), and HCPCS codes as well as patient demographics (age, gender, etc.), and place of service (if applicable), describes the eligible patient population.
There may be circumstances in which a patient who would otherwise be included in the denominator population should be excluded. In these instances, CPT Category II code modifiers (1P, 2P, and 3P) may be appended to the quality data code to indicate a medical reason (1P), patient reason (2P), or system reason (3P) for the exclusion. The 8P modifier may be used to indicate that the process of care was not performed for a reason not otherwise specified.
Each reporting option may require different numerator and denominator coding elements. Please review individual measures' specifications for applicable numerator and denominator code(s) and CPT II modifier reporting instructions.
Click here for further information about PQRS and PQRS reporting options.
You only have to choose one
reporting option to qualify for the 1.0 percent incentive payment under
the PQRS. Do not begin reporting through the PQRS until you fully
understand the various reporting options and requirements.
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