All in Good "Measure" – Don't forget 2015 PQRS cross cutting measures for anesthesiology and pain management

New in 2015 was the requirement to report at least one cross cutting (CC) measure if a provider sees one patient in a face-to-face encounter during the reporting period.

All of the CC measures are designed to be reported with Evaluation & Management (E/M) codes only. These codes include: critical care, inpatient hospital visit, and outpatient/office visit codes – and one would expect that the probability of most anesthesia providers having to report one of these codes is extremely high. For example, when anesthesia is cancelled prior to induction, the service is reported with an E/M code. These measures were specifically chosen based on denominator (E/M codes listed in the measure guidelines), topic, relevance, and the fact that the reporting of these specific measures will not be subject to the measure applicability validation (MAV) process. Eligible providers must submit at least one of these Cross Cutting measures even if just one E/M code is reported.

Measure 47 – Care Plan
This measure focuses on an Advance Care Plan or Surrogate Decision Maker. This information should be documented in the medical record specifying if the patient has one or the other or both or that an advanced care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advanced care plan. It should also be noted that properly verified oral statements carry the same ethical and legal weight as those recorded in writing. Oral conversations should be thoroughly documented within the medical record for later reference. Eligible professionals who provide critical care services and/or acute pain rounds should report this measure, which would also be applicable for anesthesia cases cancelled prior to induction in the inpatient setting.

Measure 111 – Pneumonia Vaccine
Documentation that a patient has ever received a pneumonia vaccine is required to successfully report this measure, but the measure can still be reported if the patient has not received one or one is not administered during the encounter. This scenario would be reported with an 8P modifier. The 8P modifier denotes that the quality measure has not been met. This is one of the few measures where there are no allowable performance exclusions. You either meet the requirements of the measure or you don’t. It’s important to note this measure can only be reported for those providers reporting outpatient E&M services. This would include outpatient hospital, ASC and office settings.

Measure 317 - Preventative Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
This measure is to be reported a minimum of once per reporting period, and eligible professionals who report this measure must perform the blood pressure screening at the time of a qualifying visit and may not obtain measurements from external sources. Initial screening categories include:

  • Normal blood pressure reading documented
  • Pre-hypertensive blood pressure reading documented; rescreen in a minimum of one year and recommend lifestyle modifications or, refer to alternative/primary care provider
  • Blood pressure reading not documented
  • Hypertensive blood pressure reading documented
    • First hypertensive reading
      • Rescreen within a minimum of > 1 day and < 4 weeks AND recommend lifestyle modifications or, refer to alternative/primary care provider
    • Second hypertensive reading
      • Recommend lifestyle modifications AND 1 or more of the second hypertensive reading interventions or, refer to alternative/primary care provider

With respect to the lifestyle modifications, there are several recommendations including weight reduction; dietary approaches to stop hypertension (also known as the DASH Eating Plan); dietary sodium restriction; increased physical activity; and moderation in alcohol (ETOH) consumption.

There are also secondary hypertensive interventions, including anti-hypertensive pharmacologic therapy, laboratory tests and an electrocardiogram (ECG). A patient is not eligible if he/she has an active diagnosis of hypertension or refuses to participate (either BP measurement or follow-up). The patient is in an emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status. This may include, but is not limited to, severely elevated BP when immediate medical treatment is indicated.

As stated previously, eligible providers must submit at least one of these Cross Cutting measures even if just one E/M code is reported, to maintain new reporting requirements for 2015.

Pamela Linton, CPC, CANPC is a corporate anesthesia and pain management coding specialist with Zotec Partners.

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