2016 PQRS Bronchitis Sinusitis

2016 PQRS Coding Guidelines Measure 54: EKG in nontraumatic chest pain 76: Prevention of central line infections 116: ...

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2016 PQRS Coding Guidelines Measure 54: EKG in nontraumatic chest pain

76: Prevention of central line infections

116: Acute bronchitis – avoidance of antibiotics

PQRS Code 3120F

Comment

3120F-1P 3120F-8P

Documented reason for not obtaining EKG No EKG done. No reason given.

6030F

All barriers used: hand hygiene, skin prep, cap, mask, gown, gloves, body drape. If US guidance, also sterile gel & sterile probe covers.

6030F-1P 6030F-8P

Documented reason for not using all barriers All barriers not used. No reason given

4124F

Age 18 – 64. No antibiotic prescribed.

4120F-1P

Concomitant infection, immunosuppression (HIV, cancer, transplant, etc.), underlying lung disease (emphysema, COPD, asthma, cystic fibrosis, etc.) Nursing documentation acceptable for these. Duration of sx at least 10 days. This must be in provider documentation. Antibiotics within past 30 days. This must be in provider documentation. Provider documentation of other reason for prescribing antibiotics. Antibiotic prescribed. No reason given.

4120F 331: Adult sinusitis – Antibiotic overuse (INVERSE measure)

G9286

G9505

G9287 332: Adult sinusitis – Appropriate antibiotic

G9315

G9313 G9314

Age 40+. EKG done

Age 18+. Antibiotic prescribed within 10 days of symptom onset. No reason given for prescribing antibiotics. Duration of sx must be in provider documentation. If no duration listed, assume less than 10 days. Sx duration less than 10 days. Documented reason for prescribing antibiotics. Duration of sx must be in provider documentation. If no duration listed, assume less than 10 days. No antibiotic prescribed, or duration of sx 10+ days. Age 18+. Amoxicillin or Augmentin prescribed. G9364. Use this additional code if provider documents duration of sx 10+ days, or if provider documents bacterial sinusitis. G9498. Use this additional code only if antibiotics prescribed. Documented reason for not prescribing Amoxicillin or Augmentin. G9364 and G9498 must also be coded as above. Amoxicillin or Augmentin not prescribed. No reason given. G9364 and G9498 must also be coded as above.

333: Adult sinusitis – CT overuse (INVERSE measure)

G9349

G9348 G9350 415: Adult minor head injury – CT use

G9530 and G9529

G9530 and G9531

G9530 and G9533 G9532

Age 18+. CT scan of sinuses done. No documented reason given. Use this code only if CT sinuses/paranasal sinuses ordered. Do not use this code if sinusitis identified on other CTs (head, facial bones, maxillofacial, etc). CT of sinuses done. Provider documented reason. CT sinuses not done. Age 18+. Seen within 24 hours of blunt head injury and GCS 15 and CT head ordered. Indication for CT must be documented by provider except as noted:  Age 65+ (from demographics)  Severe headache  Vomiting  Signs of basilar skull fracture  Focal neuro deficit  Thrombocytopenia (from labs or PMH)  Coagulopathy (from labs)  Anticoagulant use (from med list)  Dangerous mechanism OR Loss of consciousness OR post-traumatic amnesia PLUS provider documentation (except as noted) of:  Age 60+, less than 65 (from demographics)  Headache  Drug/alcohol intoxication  Short-term memory deficit  Evidence of trauma above the clavicles  Post-traumatic seizure See CMS measure for additional details of above Age 18+. Seen within 24 hours of blunt head injury and GCS 15 and CT head ordered. Valid other reason for ordering head CT must be documented by provider except as noted:  Ventricular shunt (from PMH)  Brain tumor (from PMH)  Multi-system trauma  Pregnancy (from labs or nursing notes)  Antiplatelet use (from med list) Age 18+. Seen within 24 hours of blunt head injury and GCS 15 and CT head ordered. No appropriate indication for head CT Use this code for any of (must be documented by provider):  Head injury > 24 hours before presentation  GCS < 15  head CT ordered by someone other than Emergency care provider  CT ordered for reason other than trauma