Elderly woman

How one PQRS AMD code can save you future penalties

The PQRS advice that applies to treating diabetes and glaucoma patients also applies to treating age-related macular degeneration (AMD). If you treat just one Medicare patient with AMD before 2013 ends, you can avoid penalties coming in 2015.

A good-faith effort can mean as little as providing PQRS quality of care measures to a single patient.

To avoid having Medicare reimbursements docked 0.5 percent in 2015 under the Physician Quality Reporting System (PQRS), you must make "a good-faith effort" to provide quality patient care for AMD. According to Medicare, a good-faith effort can mean as little as providing PQRS quality of care measures to a single patient over the course of a year.

However, Rebecca Wartman, O.D., AOA Third Party Center Executive Committee member, recommends getting in the practice of using PQRS codes more regularly. In the future, using them will help you not only avoid penalties but also earn bonuses. 

PQRS measures for AMD

There are two PQRS measures related to the diagnosis of macular degeneration. These apply only to patients age 50 and older:

  • No. 14—Age-Related Macular Degeneration: Dilated Macular Examination
  • No. 140—Age-Related Macular Degeneration: Counseling on Antioxidant Supplement

You may use one or both of these measures with any of the following three AMD diagnoses codes: 

  • 362.50—Macular degeneration NOS
  • 362.51—Macular degeneration, non-exudative
  • 362.52—Macular degeneration, exudative

Measure No. 14, reported on claims using QDC 2019F, indicates you had a dilated view of the macula and documented the presence or absence of macular thickening.

You must dilate and record findings once per 12-month period or once per reporting period. However, the quality data code (QDC) must be used on every claim submitted for the AMD diagnosis—even when the dilated macular examination was performed during a previous patient visit.

For cases when you could not provide a dilated examination, the PQRS provides exceptions, which can be noted on claims with the following modifiers:

  • 1P—Medical reason for no dilated macular view
  • 2P—Patients reason for no dilated macular view
  • 8P—Other reason for no dilated macula view

However, practitioners should use such exceptions, particularly 8P, judiciously.

Measure No. 140, reported on claims using QDC 4177F indicates you discussed the pros and cons of the Age-Related Eye Disease Study (AREDS) formulation of antioxidant supplements, made proper recommendations for the patient and documented the discussion per the AREDS report.

You must discuss and document recommendations once per 12-month period or once per reporting period for each patient. However, the QDC must be used on every claim submitted for the diagnosis, even when the AREDS discussion occurred during a prior patient visit.

The only exception for 4177F is 8P—No reason for not discussing AREDS.

For more details, use the AOA Summary Chart of PQRS coding.

Related stories:

How one PQRS diabetes code can save you future penalties

How one PQRS glaucoma code can save you future penalties

December 3, 2013

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