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  • Physician Quality Reporting System Measure Specifications

    The 2013 Physician Quality Reporting System (PQRS) includes 259 measures that are reportable by physicians and non-physician healthcare professionals. In general, the quality measures calculate the percentage of eligible patients who receive a particular process of care or achieve a particular outcome such as Community-Acquired Pneumonia (CAP): Assessment of Mental Status.

    PQRS Measure Specifications Table of Contents

    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 consists of a CPT Category I code and ICD-9 code(s), describes the eligible patient population. Please review individual measures' specifications for applicable numerator and denominator coding requirements. Changes to the 2013 PQRS can be found on the CMS website.

    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. Please review individual measures' specifications for CPT II modifier reporting instructions. 

     

     

    Numerator

    =

    CPT II code and/or G-code + CPT II modifier if applicable

    Denominator

    CPT I code + ICD-9 code(s)


     Medicare claims must be properly filled out or data must be submitted to a qualified registry in order to demonstrate successful PQRS reporting. Click here for further information about PQRS reporting options. Medicare data reveals that physicians who reported on PQRS measures through a "qualified registry" are much more likely to earn incentive payments than their peers who choose the claims-based reporting option.

 

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