How one PQRS glaucoma code can save you future penalties

If you treat even a single Medicare patient with glaucoma during the remainder of 2013, you can avoid penalties coming in 2015.

Be sure to document any plan of care in the patient record.

Just as with diabetes care, all that is necessary to avoid having Medicare reimbursements docked 0.5 percent in 2015 under the Physician Quality Reporting System (PQRS) is "a good-faith effort" to provide quality patient care. That good-faith effort can mean as little as providing PQRS quality of care measures to a single appropriate patient over the course of a year.

However, it's best to get in the practice of using PQRS codes on a regular basis, said Rebecca Wartman, O.D., AOA Third Party Center Executive Committee member. Doing so may even earn you bonuses instead of just helping you avoid penalties.

Measures for glaucoma

There are two PQRS measures—Measure No. 12 and Measure No. 141—for the diagnosis of glaucoma. If any of the following glaucoma diagnoses are coded for a patient age 18 or older, you may use one or both of these measures:

  • 365.10: Open-Angle Glaucoma, unspecified
  • 365.11: Primary Open-Angle Glaucoma
  • 365-12: Low-Tension Glaucoma
  • Note: Diagnosis codes 365.70-365-74 were not included for 2013.

Measure #12, using the QDC 2027F, indicates you viewed the optic nerve with or without dilation. You must document the results of the optic nerve view once for each 12-month period or once per reporting period for each unique patient. However, the QDC must be used on every claim submitted for the glaucoma diagnosis, even when the optic nerve view occurred during a prior patient visit.

The exceptions for 2027F are:

  • 1P: Medical reason for not viewing optical nerve
  • 8P: No reason for not viewing optical nerve

Measure #141 has three different codes to consider with several different code combinations. QDC 3284F is used to indicate when the IOP is reduced 15 percent or more from pre-intervention levels. QDC 3285F is used when IOP is not reduced 15 percent from pre-intervention levels, and 0517F is added to indicate that a plan of care to reduce intraocular pressure (IOP) levels is in place.

Exceptions are as follows:

  • 3284F: 8P—IOP not documented, no reason given
  • 3285F: No exceptions because 3284F—8P is used if IOP is not measured
  • 0517F: 8P—No plan of care documented to reduce the IOP

For QDC 0517F, a plan of care might include rechecking IOP at a specified time, a change in therapy, a plan to perform additional diagnostic evaluations, monitoring of IOP per the patient's decision, indicating that the target IOP cannot be achieved because of systemic health reasons, or referral to a specialist.

Be sure to document any plan of care in the patient record, Dr. Wartman emphasized.

For guidance, AOAExcelTM offers a SummaryChart of PQRS Coding.

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November 19, 2013

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