2009 Physician Quality Reporting Initiative PQRI
The Centers for Medicare and Medicaid Services (CMS) have posted the 2009 Physician Quality Reporting Initiative (PQRI) program measures and specifications. They are available at
http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage
Anesthesiologists planning to participate in the 2009 PQRI program should take note of the revised specifications associated with Measure #30 and Measure #76.
Measure 30 Timing of Prophylactic Antibiotics - Administering Physician
The Numerator: Surgical patients with an order for a prophylactic antibiotic for whom administration of the prophylactic antibiotic has been initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required)
The numerator reporting options are:
Report CPT Category II code 4048F when Prophylactic Antibiotic was Given Within Specified Timeframe
Report CPT Category II code 4048F with modifier 1P when Prophylactic Antibiotic not Given for Medical Reasons (eg, contraindicated, patient already receiving antibiotics)
Report CPT Category II code 4047F with modifier 8P when Prophylactic Antibiotic not OrderedReport CPT Category II code 4048F with modifier 8P when Prophylactic Antibiotic Ordered but not Given Within One Hour, Reason not Specified
The Denominator: All patients aged 18 years and older who require anesthesia services where a prophylactic antibiotic is commonly indicated for associated surgical procedures
Anesthesia codes for which prophylactic antibiotics are commonly indicated for associated surgical procedure(s):
00100, 00102, 00103, 00120, 00140, 00145, 00147, 00160, 00162, 00164, 00170, 00172, 00174, 00176, 00190, 00192, 00210, 00211, 00212, 00214, 00215, 00216, 00218, 00220, 00222, 00300, 00320, 00322, 00350, 00352, 00400, 00402, 00404, 00406, 00450, 00452, 00454, 00470, 00472, 00474, 00500, 00528, 00529, 00530, 00532, 00534, 00537, 00539, 00540, 00541, 00542, 00546, 00548, 00550, 00560, 00561, 00562, 00563, 00566, 00567, 00580, 00600, 00604, 00620, 00622, 00625, 00626, 00630, 00632, 00634, 00670, 00700, 00730, 00750, 00752, 00754, 00756, 00770, 00790, 00792, 00794, 00796, 00797, 00800, 00802, 00820, 00830, 00832, 00840, 00844, 00846, 00848, 00851, 00860, 00862, 00864, 00865, 00866, 00868, 00870, 00880, 00882, 00902, 00904, 00906, 00908, 00910, 00912, 00914, 00916, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938, 00940, 00942, 00944, 01120, 01140, 01150, 01170, 01173, 01180, 01190, 01202, 01210, 01212, 01214, 01215, 01230, 01232, 01234, 01250, 01260, 01270, 01272, 01274, 01320, 01360, 01382, 01392, 01400, 01402, 01404, 01430, 01432, 01440, 01442, 01444, 01464, 01470, 01472, 01474, 01480, 01482, 01484, 01486, 01500, 01502, 01520, 01522, 01610, 01622, 01630, 01632, 01634, 01636, 01638, 01650, 01652, 01654, 01656, 01670, 01710, 01712, 01714, 01716, 01732, 01740, 01742, 01744, 01756, 01758, 01760, 01770, 01772, 01780, 01782, 01810, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01924, 01925, 01926, 01951, 01952, 01953, 01961, 01962, 01963, 01965, 01966, 01968, 01969
ASA has received clarification from CMS that anesthesiologists who report this measure for cases not included in the denominator will not be penalized when CMS analyzes claims to determine successful reporting.
Measure #76: Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol
The denominator for this measure will include CPT code 93503 for the 2009 PQRI program.
The Numerator: Patients for whom central venous catheter (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
The Denominator: All patients, regardless of age, who undergo CVC insertion
(CPT codes: 36555, 36556, 36557, 36558, 36560, 36561, 36563, 36565, 36566, 36568, 36569, 36570, 36571, 36578, 36580, 36581, 36582, 36583, 36584, 36585, 93503)