Medical Billing Forum

Coding => Coding => Topic started by: dans169 on January 11, 2016, 01:43:30 PM

Title: PQRS guidance needed urgently
Post by: dans169 on January 11, 2016, 01:43:30 PM
Hi everyone,
Having a PQRS freak out here.

First here’s some background on the practice and billing. With our Medicare folks we are primarily billing neuropsych testing codes with dementia related dx’s for the evaluation. We see about 250 per year for dementia related evals.

Some of these folks will continue coming in after their evaluation to do therapy for mental health issues such as MDD, anxiety, adjustment d/o  etc…. So we end up billing a 90837 with a MH dx dependig on the symptoms being addressed.

Here’s where PQRS comes in:

We started reporting in 2013 via claims and reported on the dementia measures group only, as that seemed to be the only applicable group that covered our CPT, DX combo.

Well, apparently, PQRS changed from the dementia measures group being able to be reported via claims and made it registry only.  We have all the data for 2015 and it seemed like there is still time to get set up with a registry and report the measures.

The registry rep said if we are going to do a measures group we only have to report on a 20 patient sampling, they recommend 25. No problem here, would be easy enough since we have the data.

Here’s where I’m confused: What about the individual measures related to the therapy codes (90837)?

90837 is listed across several non dx specific measures in PQRS. I take it this means we should have been reporting all measures applicable to this CPT if the criteria are met. 

The registry rep told me it was either one or the other, you report a measures group, or you can report individual measures.

So if we report on our 20 pt sample for the dementia group through the registry for 2015 does that mean we are free of having to report on all the individual measures for the therapy visits such as 90837 etc.…?  -- Ths is my biggest question

The rep went on about how it wasn’t fair if you were a general psychologist and there was no measures group you could report, you had to report on 50% of your eligible patients for 9 measures and there was huge discrepancy vs measures group reporting of the 20 pt sample.

Were not looking to get the incentive here, just avoid the penalty and I don't want to scramble to get set up with the registry to report the dementia measures if we're going to get penalized anyway for not reporting measures for the 90837's.

If we do have to report individual measures since we are using 90837 how would that work? Report our 20 pt sample through the registry for the dementia group and then the 50% of eligible patients for the 9 individual measures.

Thanks so much, sorry if the above is confusing

Title: Re: PQRS guidance needed urgently
Post by: Michele on January 12, 2016, 08:47:24 AM
Wow, sounds like you've done your homework.  Unfortunately I am not familiar with registry reporting so I don't know the answer to your question.  Is there any way you can speak to another registry rep who might be able to answer your question?  Your question seems very specific and well put.  I would either try to get another registry rep or re-ask the one you spoke with.  Just explain you are still unclear on one thing.  Maybe if you are only asking the one specific question the answer will be clearer.  But from what you've described below it seems as though you do not have to worry about the individual measures if you are doing registry reporting.