For 2013 there are 2 groups of PQRS codes that are mandatory from Medicare; in 2012 there were 3 groups. The third item that was required in 2012 must be shut off for 2013 because using it will result in rejection of claims. There are a few other codes that are required in order to comply with Meaningful Use, which are described later in this manual. There are many codes that are optional, based on the combination of [a] if you perform the specific service or function and [b] whether or not you want to report it.
The item to shut off for 2013 is the use of G8447 or G8448, the code that tells Medicare that the documentation was created using certified EHR software. In 2012, in order to simplify the entry of this code, it was tagged to 3 specific items in the Plan window of ChiroPadEMR which then generated G8447 or G8448 on the ChiroOffice Transaction window. Each of those items ended with “PQRS”.
So for 2013 do NOT use
•Adjustment 1-2 Regions PQRS
•Adjustment 3-4 Regions PQRS
•Adjustment 5 Regions PQRS
Shut off these 3 items by opening the ChiroPadEMR Customization section (figure 1).
Figure 1
Click on the plus (+) next to Plan, then click Modalities (figure 2).
Figure 2
From the Modality list, select the item and make it Inactive. Finalize the shut off by clicking Save. (figure 3)
Figure 3
The mandatory codes MUST be used for at least 50% of Medicare claims generated by the practice during calendar year 2013 or, beginning in 2015, Medicare will penalize the practice by reducing Medicare payments to the practice.
The 2 PQRS groups that are mandatory for 2013 are referred to as Meaningful Use Measure # 131 (Pain Assessment and Follow-up) and Measure # 182 (Functional Outcome Assessment). Although they sound similar, these groups are significantly different. Medicare uses terminology differently than doctors, so certain words and phrases that doctors think they understand means something totally different to the Medicare bureaucrats.
•Pain Assessment and Follow-up (Measure # 131) refers to the doctor assessing the patient for pain on each and every visit, BEFORE performing any kind of care or treatment. It is as simple as noting a 0 to 10 Pain Scale in the SOAP notes on the Subjective Complaint window (figure 4). This assessment is part of the evaluation that determines the course of action (follow-up plan) ON THAT VISIT.
Figure 4