Question: Measure 145, Exposure Time Reported for Procedures Using Fluoroscopy, of the Physician Quality Reporting Initiative program requires the reporting of a Category II when fluoroscopy is used. If fluoroscopy is associated with multiple codes reported on the same claim form, should you report the fluoroscopy Category II code multiple times? For example, a claim lists angiography codes 75680, 75671, and 75685 on the same claim. Does the physician need to list the Category II code 6045F more than once?

If multiple procedure codes on a claim form are all part of the same measure and are listed in the denominator for the measure (such as 75680, 75671, and 75685), and the Category II quality data code applies to all three procedure codes, then the Category II code would need to be listed only once on the claim. Medicare will count the Category II code toward all applicable (denominator) Category I procedure codes on the claim.

Question: We are currently reporting three measures in the Physician Quality Reporting Initiative program. Are we required to also report on measure 147, Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy, if we also perform this procedure? If we don't report measure 147, will it affect our bonus?

If you are reporting on three measures and elect not to report on a fourth measure, your bonus will not be affected. However, if you are reporting only on one or two measures and this third measure applies to your practice and you do not report on this measure, your bonus may be affected. If three measures apply, you are required to report on at least those three measures.

Question: What is the measure-applicability validation process that will be used with the 2009 Physician Quality Reporting Initiative?

The Centers for Medicaid and Medicare Services (CMS) has posted the measure-applicability validation (MAV) process for 2009 Physician Quality Reporting Initiative (PQRI). This process will be used to determine satisfactory PQRI reporting for participants who achieve a reporting rate at or above 80 percent for each of fewer than three measures submitted through claims. The validation process will analyze whether participants should have submitted Category II quality-data codes for additional measures. Five measures that are potentially reportable by radiologists are "clustered" together for such determination. These are measures 10, 11, 145, 146, and 147. For greater detail on how the 2009 PQRI MAV process is implemented, see the document titled "2009 Measure-Applicability Validation Process for Claims-Based Participation," which is available in the "Analysis and Payment/Downloads" section of the CMS Web site at http://www.cms.hhs.gov/PQRI/25_AnalysisAndPayment.asp#TopOfPage. If you have any questions, contact P4Pquestions@acr.org.

Question: If a bone scintigraphy report recommends an additional study for correlation, how should that study be reported under the Physician Quality Reporting Initiative program?

Measure 147 was established to identify instances in which a bone scintigraphy final report does not document correlation to existing imaging studies. When a bone scintigraphy report recommends an additional study for correlation, the Category II code 3570F with the 3P modifier should be reported to designate that the patient did not have a previous relevant clinical exam. If, however, the patient did have a previous relevant study performed, but it was not available for comparison, modifier 8P should be reported to designate the reporting action was not performed.

Question: If I use fluoroscopic guidance for the performance of a percutaneous abscess drainage and report 75989 (Radiologic guidance, ie, fluoroscopy, ultrasound, or computed tomography), do I have to report the fluoro time? Why is this code not listed in measure 145, Exposure Time Reported for Procedures Using Fluoroscopy?

Codes that describe procedures that may or may not be performed with fluoroscopy, such as 75989 (Radiologic guidance, ie, fluoroscopy, ultrasound, or computed tomography) for percutaneous drainage…), are not included in measure 145. If such codes were to be listed in the measure, physicians who perform these procedures without fluoroscopic guidance would be inappropriately expected to report the Category II code listed for this measure. Because of these limitations in physician coding, the [PQRI consortium] workgroup removed codes that do not clearly identify the use of fluoroscopy.

The 2009 Physician Quality Reporting Initiative (PQRI) program has implemented measure 145 to monitor the long-term effects of radiation by measuring the exposure time or radiation dose that a patient receives as a result of a procedure. This measure is intended to track when the exposure time or radiation dose has been documented in the patient's final report. If participating in the PQRI program and reporting this measure, you should note the fluoroscopy time or the radiation dose in your final reports.