Clarification on PQRI Measure #145 – Exposure Time Reported for Procedures Using Fluoroscopy
Clarifying information for reporting one of the diagnostic radiology measures included in the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting Initiative (PQRI) has been issued by CMS. Please see detailed clarification below.
Measure #145, Exposure Time Reported for Procedures Using Fluoroscopy, instructs that final reports for procedures using fluoroscopy should include documentation of radiation exposure or exposure time.
Additional information on PQRI.
Clarification helpful for coding and reporting the measure:
The final 2009 measure specification for PQRI Measure #145 includes 22 CPT Category I codes for radiology procedures in the denominator that do not include the use of fluoroscopy. The specifications provided to CMS by the measure developer (AMA - PCPI /NCQA ) inadvertently included 22 CPT codes for non-fluoroscopy radiology procedures in the denominator. Once PQRI measure specifications are finalized, it is CMS policy not to make changes to the specifications during the reporting period. After the codes were finalized and the 2009 reporting period had begun, it was brought to the measure developer’s and CMS’ attention whether these 22 CPT codes should have been included in the measure’s denominator. After reviewing the issue with the measure developer, it has been concluded that these codes should not belong in the measure. Since the PQRI measure specifications are final as posted on the CMS PQRI Web site, CMS is providing an analytic fix for this measure so as not to disadvantage eligible professionals.
CMS and the measure developer recommend that you do not change how you have been reporting Measure #145 and that you continue to report in the manner in which you have been reporting for the 2009 reporting period. Review the 22 identified non-fluoroscopy codes (36597, 64510, 64520, 64622, 64626, 74400, 74410, 74415, 74420, 75820, 75822, 76100, 76101, 76102, 76150, 77031, 77053, 77054, 77071, G0259, G0260, and G0365) to determine the manner in which you have been reporting on or after 1/1/2009:
If you have been reporting 6045F with the 8P modifier (action not performed, reason not otherwise specified) for the 22 non-fluoroscopy codes, you should continue to report the 8P modifier for those codes.
OR
If you have not reported any quality-data code (QDC) for the 22 non-fluoroscopy codes, do not start reporting QDCs on these codes now.
CMS will calculate two different reporting rates for each individual National Provider Identifier (NPI) for this measure and will use the most favorable reporting rate. The performance rate will exclude the 22 non-fluoroscopy codes.
This information was posted on the CMS PQRI FAQ Web site on March 31, 2009, as FAQ #9675. Please contact P4Pquestions@acr.org with questions.
