Important Update: PQRS – Are you reporting the required codes to ‘dodge’ future Medicare payment adjustments/reductions?

Important Update: PQRS – Are you reporting the required codes to ‘dodge’ future Medicare payment adjustments/reductions?

by abilling, October 1, 2013

ABI recently learned it is not required you report on at least 50% of your 2013 Medicare claims, as originally thought and reported to you, to keep from receiving a reduction in your 2015 Medicare reimbursements.  This 50% reporting requirement is only required if you are trying to receive incentive money for PQRS.

HOWEVER, it is required you report a PQRS measure on AT LEAST one Medicare claim, per individual provider, in 2013 to divert the 2015 reduction in your Medicare payments.  Therefore, each member of your group will need to submit a PQRS measure on at least one Medicare claim in 2013.  There is still a requirement, BUT IT IS NOT TOO LATE!!  The format to submit that measure has not changed…

The simplest and most widely used method to report the PQRS measure(s) is via claims; however, you do have other options.  Using the claims method, eligible professionals simply include a 5-digit code on each claim they submit to Medicare.  You can report this code on a Medicare eligible charge to us.  We will affix the code(s) to the claim submitted to Medicare.

It is easy to add these measures to all billings.  Simply modify the information you provide your billing office with something similar to the following.


PQRS Antibiotic Administration (Measure #30)   PQRS Perioperative Temperature Management (Measure #193)
Antibiotic Timely Delivered – 4048F   x Duration of general or neuraxial anesthesia less than 60 min – 4256F
Not Delivered – Medical Reasons – 4048F-1P   MAC Anesthesia or Peripheral Nerve Block less than 60 min – 4256F
Not Delivered – Unspecified Reasons – 4048F-8P    ** if either of the 2 boxes are checked – don’t go any further **
x Antibiotic Not Ordered – 4047F-8P   Active Warming Performed; 60 min or longer – 4250F & 4255F
PQRS CVC Insertion (Measure #76)   Active Warming Not Performed; 60 min or longer – 4250F-1P & 4255F
Sterile Technique Followed – 6030F   Active Warming Not Performed or Not Achieved, reason not otherwise specified; 60 min or longer – 4250F-8P & 4255F
Not Followed – Medical Reasons – 6030F-1P    
Not Followed – Unspecified Reasons – 6030F-8P   PQRS Radiology Exposure Fluoroscopy Time Reported (Measure #145)
    Radiation Exposure or Exposure Time Documented – 6045F
    Radiation Exposure or Exposure Time NOT Documented – Unspecified Reasons – 6045F-8P



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Reasonable attempts have been made to be accurate.  However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ.  Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations.  For information specific to your practice, consult a qualified professional.

The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice.  Specific questions about how this information affects your particular situation should be addressed to your attorney.

Editor:  Philip Blann (

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