Overview

The 2011 PQRS (formerly known as PQRI) consists of 194 quality measures and 14 measure groups.  For anesthesiologists there are 3 measures that will be used for reporting.

The measures are as follows:
•  Measure #30: Perioperative Care: Timely Administration of Prophylactic Parenteral Antibiotics
•  Measure #76: Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol.
•  Measure #193: Perioperative Temperature Management

Incentive amounts for participating in the 2011 PQRS Program between January 1 – December 31, 2011 equals 1.0% of the estimated total allowed charges for covered Medicare Part B Physician Fee Schedule services.  To be eligible, providers must report at least 50% of applicable cases, for each measure.  Earned incentive payments will be paid to the TIN under which the incentive-earning professional submitted PQRS claims.

There are two optional reporting periods for 2011:

•  January 1, 2011 – December 31, 2011
•  July 1, 2011 – December 31, 2011*

The provider must accurately report the services given. Be aware that you cannot go back to report PQRS information once the claim has been sent. * If you missed the first reporting period it’s not too late. Contact your client manager to discuss PQRS reporting beginning July 1, 2011.

Major Changes for 2011:

•  CMS requires that if three or more measures apply, the eligible professional must report at least 50% of applicable cases on at least three measures.
•  Groups must report at least 50% on all 3 measures that apply to anesthesiologists.

 


Measure #30:
Perioperative Care: Timely Administration of Prophylactic Parenteral Antibiotics

CMS Description: Percentage of surgical patients aged 18 years and older who receive an anesthetic when undergoing procedures with the indications for prophylactic parenteral antibiotics for whom administration of the prophylactic parenteral antibiotic ordered has been initiated within one hour (if fluoroquinolone or vanvcomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required).

2011 Codes:
•  4047F-8P: antibiotic NOT ordered
•  4048F: administered within specified timeframe
•  4048F-1P: antibiotic NOT administered for medical reasons
•  4048F-8P: antibiotic ordered but NOT initiated within one hour, reason not specified.

 


Measure #76:
Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol

CMS Description: Percentage of patients, regardless of age, who undergo CVC insertion for whom CVC was inserted with all elements of maximal sterile barrier technique [cap AND mask AND sterile gown AND sterile gloves AND a large sterile sheet AND hand hygiene AND 2% chlorhexidine for cutaneous antisepsis (or acceptable alternative antiseptics per current guideline)] followed.

 

2011 Codes:
•  6030F: all elements of maximal sterile barrier technique followed
•  6030F-1P: all elements of maximal sterile barrier technique NOT followed for medical reasons
•  6030F-8P: all elements of maximal sterile barrier technique NOT followed, reason not specified

 

 


Measure #193:
Perioperative Temperature Management

CMS Description: Percentage of patients, regardless of age, undergoing surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer, except patients undergoing cardiopulmonary bypass, for whom either active warming was used intraoperatively for the purpose of maintaining normothermia, OR at least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) was recorded within 30 minutes immediately before or the 15 minutes immediately after anesthesia end time.

Definition: For purposes of this measure, “active warming” is limited to over-the-body active warming (e.g., forced air, warm-water garments, and resistive heating blankets.)

Active Warming Used Intraoperatively OR at Least One Body Temperature Equal to or Greater than 36 Degrees Centigrade Recorded Within Designated Timeframe:
(Two CPT II codes [4250F & 4255F] are required on the claim form to submit this numerator option.)

4250F: Active warming used intraoperatively for the purpose of maintaining normothermia, OR at least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time.
AND
4255F: Duration of general or neuraxial anesthesia 60 minutes OR longer, as documented in the anesthesia record

 

Active Warming Not Performed OR at Least One Body Temperature Equal to or Greater than 36 Degrees Centigrade not Achieved Within Designated Timeframe for one of the following Medical Reasons:
(Two CPT II codes [ 4250F-1P & 4255F] are required on the claim form to submit this numerator option.)

4250F-1P: Intentional hypothermia OR active warming not indicated due to anesthetic technique: peripheral nerve block without general anesthesia, OR monitored anesthesia care
AND
4255F:
Duration of general or neuraxial anesthesia 60 minutes or longer, as documented in the anesthesia record

If patient does not meet denominator inclusion because anesthesia time as indicated on anesthesia record is less than 60 minutes duration:
(One CPT II code [4256F] is required on the claim form to submit this numerator option)

4256F: Duration of general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record

Active Warming Not Performed OR at Least One Body Temperature Equal to or Greater than 36 Degrees Centigrade Not Achieved Within Designated Timeframe, Reason Not Specified:
(Two CPT II codes [4250F-8P & 4255F] are required on the claim form to submit this numerator option)

4250F-8P: Active warming not performed OR at least one body temperature equal to or greater than 36 degrees Centigrade NOT achieved within designated timeframe, reason not otherwise specified
AND

4255F: Duration of general or neuraxial anesthesia 60 minutes or longer, as documented in the anesthesia record

 


Centers for Medicare & Medicaid Services. “2011 Physician Quality Reporting System (Physician Quality Reporting) Measures List.” PDF Version 5.2. March 31, 2011. http://www.cms.gov/PQRS//15_MeasuresCodes.asp#TopOfPage.
Measure #30 page 4
Measure #76 page 10
Measure #193 page 24

License for Use of Current Procedural Terminology, Fourth Edition (“CPT®”) CPT codes, descriptions and other data only are copyright 2010 American Medical Association.  All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). http://www.cms.gov/apps/ama/license.asp?file=/pqrs/downloads/2011_PhysQualRptg_MeasureSpecificationsManual_033111.pdf

Centers for Medicare & Medicaid Services. “2011 Physician Quality Reporting System (Physician Quality Reporting) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures.” PDF Version 5.3. March 31, 2011. http://www.cms.gov/apps/ama/license.asp?file=/pqrs/downloads/2011_PhysQualRptg_MeasureSpecificationsManual_033111.pdf
Measure #30 pages 81-84
Measure #76 pages 176 – 178
Measure #193 pages 447 – 450

 

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abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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