Question: Office Visit with PRQS Billing?


I came across a question on PQRS billing and thought you would benefit from this information. Please let me know your thoughts and if you have further questions, please contact us.

Question: Do we bill Medicare for an E/M service (e.g., CPT 99212) when we perform exam for PQRS (Measures 126, 127, 163) on same day as diabetic nail debridement?

If no office visit is billed, what is correct coding scenario?

Answer: The answer to your question is, yes, you need to have an E/M or other qualified code on the claim in order to use one or more of the PQRS measure codes.

When billing an E/M service, you will be required to meet the E/M service level requirements showing a medical necessity for evaluation and management performance/reimbursement on the same day as a “covered” routine foot care or nail debridement code. You cannot bill an E/M code simply because you performed one or more PQRS measures. The PQRS measures are in addition to and not in place of the E/M components.

So, if your Foot Care LCD is anything like the one TrailBlazer has, it will say that you will need a separate and identifiable reason (different diagnosis) to bill an E/M code on the same day as the covered routine foot care or debridement services. For the same reason you cannot bill an E/M to re-qualify a patient for “covered” care, you cannot bill an E/M to perform the PQRS measures.

PQRS tracking is “per individual NPI” and is unrelated to tax ID.  Each doctor is tracked separately.

FYI, PQRS (formerly known as PQRI) offers podiatrists an end of year bonus of 1% of the total annual amount paid by Medicare by reporting that an examination was performed on patients with Medicare and diabetes to evaluation circulatory status, neurological status and to assess shoe fit.  For a more complete explanation of how to earn the PQRS bonus please register for the free webinar, “The CDFE Strategy” offered twice each week at www.safestep.net, “Free Training”.

Categories : PQRS

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