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Reminder on PQRS Measures – Codes to Use and Documentation of Measures

Two of the PQRS measures that are reported by anesthesia practices are the Prophylactic Administration of Antibiotics and the use of Maximum Sterile Barrier Technique for Catheter Insertions to prevent infections (MSBT). These two measures represent one of the reportable “clusters” that qualify for the PQRS incentive bonus payment when reported on at least 50% of the qualifying cases. Outlined below is information that you need to know when documenting the anesthesia record.

Prophylactic antibiotic administration:

  • 4048F – Antibiotic ordered and given w/in 1 hr (2 hr for Fluoro/Vanc)
  • 4048F – 1P Antibiotic ordered but not given for medical reasons
  • 4048F – 8P Antibiotic ordered but not given timely
  • 4047F – 8P Antibiotic NOT ordered

Please note that if the patient is already on antibiotics prior to the surgery, you should be billing the 4048F-1P code (antibiotic ORDERED but not given for medical reasons). It would also be helpful for you to notate that the ‘pt is already on ABX’.

When you bill 4047F-8P (Antibiotic NOT ordered), this means there is no order AND the patient is not currently on antibiotics.

Maximum Sterile Barrier Technique (MSBT) for Catheter Infection Prevention:

For this measure, you should indicate in the remarks section on the anesthesia record (‘sterile technique followed’) and if you use a charge sheet that the insertion of the CVP line or Swan Ganz was done using MSBT (6030F). Also, in the patient chart you should document that each individual component of MSBT (cap, gown, etc.) was met.

Lastly, please remember that the PQRS BONUS PAYMENT is calculated on a per Physician basis (i.e., one physician in a group may qualify while another does not). Each Physician must report the standard 50% of the time on BOTH measures. For example, if you report the measure on prophylactic antibiotics, but do 30 line insertions and forget to document 16 of those, you lose the bonus. Feel free to contact us if you have any questions or need additional information. 

By: Susan Hargrave, MBA, Vice President of Operations

On Thursday, May 26, 2011

Categories: Compliance & Coding News

The information presented herein reflects general information that is current as of the date it was first published. Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.

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