PQRI reporting in 2010 (Physician Quality Reporting Initiative )

What is the “frequency?”
 The frequency refers to how often the measure should be reported. Measure #20 should be reported each time an applicable procedure is performed during the reporting period (full or half-year).

What is the performance time frame?
The performance time frame for measure #20 is indicated as within one hour (two hours if fluoroquinolone or vancomycin) prior to surgical incision, or start of procedure when no incision is required.

How do I report measure #20 via claims?
The measure specifications for measure #20 indicate that it is a claims and registry measure, meaning it can be reported using either the claims-based or the registry-based method. This article looks at the claims-based method only. The Current Procedural Terminology (CPT) codes and patient demographics identify the patients who are included in measure #20, otherwise known as the denominator. The Measure Specifications Manual, there is a listing of all surgical procedures and CPT codes that qualify patients as eligible to meet this measure’s inclusion requirements. It is important to review the CPT codes associated with each measure reported. Also, please note that the included procedure codes may change from year to year, so review the 2010 measure specifications before beginning to report for this year.

What are the steps to be taken after identifying a patient in the denominator for Measure #20?

CPT II codes, or quality data codes (QDCs), are used to report the clinical action required by the measure on the claims form. For measure #20, there are four choices: 4047F, 4048F, 4047F with 1P and 4047F with SB 4047F indicates the order for prophylactic parenteral antibiotics was given; 4048F indicates prophylactic parenteral antibiotic has been given; 4047F with 1P modifier indicates the order for prophylactic parenteral antibiotic was not given due to medical reasons; and 4047F with SP modifier indicates prophylactic pare nteral antibiotic was not given and the reason was not specified. Please note that both the CPT code and the appropriate CPT II code should be submitted on the same claim form.

It is important to note that for measure #20, Table 2 (this page) is included in the measure specifications and lists the antimicrobial drugs considered prophylactic parenteral antibiotics for the purposes of this measure. Code 4047F-8P should be reported when antibiotics from this table were not ordered.