PQRI for Anesthesia
There are some important changes to the two PQRI measures reported with anesthesiology services:
1. Measure #30, Timing of Prophylactic Antibiotic-Administering Physician
There will be a major change to the denominator reporting of Measure #30. In 2007 and 2008, physicians could report antibiotic prophylaxis in every anesthesia case on a patient aged 18 years or older for whom there was an order for an antibiotic, by entering code 4047F (as the denominator code) on the claim form. Do not use code 4047F next year.
In 2009, the patient population to which the measure will apply (the “denominator”) will be defined not by the existence of an order for a prophylactic parenteral antibiotic, but instead by the anesthetic given. If, for example, you are submitting a claim for anesthesia for a CABG (code 00560) or one of 217 other specific anesthesia codes, you will be able to report giving the antibiotic. The new denominator codes are listed on the attached pages from the CMS 2009 PQRI Measure Specifications Manual. If the patient falls into the denominator population because one of the 218 codes applies, then the physician should report:
4048F antibiotic given within one hour [if fluoroquinolone or vancomycin, two hours] prior to surgical incision [or start of procedure when no incision is required], or
[New] 4048F-1P antibiotic not given for medical reasons (e.g., contraindicated) documented in the anesthesia record, or
4048F-8P antibiotic not ordered, or ordered but not given within timeframe; reason not otherwise specified.
2. Measure #76, Prevention of Catheter-Related Bloodstream Infections (CRSBI) Central Venous Catheter Insertion Protocol
This measure is now reportable together with a Swan Ganz insertion (CPT 93503) so it becomes much more important than it was last year, when it could only be reported with 36555…36585.
Instead of making 2% chlorhexidine the only acceptable antiseptic, the measure specification now allows “acceptable alternative antiseptics per current guideline.”
All the details are in the attached CMS Measure Specifications for ## 30 and 76. You may also find the attached PQRI Implementation Guide useful — it has extensive sample documentation. And if you want to know about other measures (NB– #75, the critical care measure for head-of-bed-elevation to prevent ventilator-associated pneumonia, has been deleted) or about the additional 2% bonus available for using certified EMRs (are there any for anesthesia) or other PQRI wonders, CMS last week posted a raft of new materials at http://www.cms.hhs.gov/PQRI/ and more specifically at http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage.