New CPT II Coding for PQRI Reporting
In an effort to eliminate confusion when reporting on Physician Quality Reporting Initiative (PQRI) pathology measures, the CPT Editorial Panel has created a new CPT Category II code used to report tissues other than breast and colon. Code 3250F (Specimen site other than anatomic location of primary tumor) will now be reported when tissue other than primary breast or colon tissue meets reporting standards.
EXAMPLE: A liver biopsy is performed on a patient with a current diagnosis of primary breast cancer. If the liver biopsy is diagnosed as benign, the breast cancer diagnosis 174.9 (Malignant neoplasm of female breast, unspecified) is assigned to the case. The combination of the 88307 CPT code (Liver, biopsy-needle/wedge) and the 174.9 diagnosis code would qualify the case for the PQRI program.
In 2008, this type of case was reported with the 3260F-1P (Documentation of medical reason (s) for not including pT category, pN category and histologic grade in the pathology report). For 2009, the addition of code 3250F allows pathologists to more accurately report the reason why grading and staging was not included in the report. The code is eligible for use with the breast and colon measures. Pathologists participating in the PQRI program should begin using the new code immediately.
CMS has announced a 2% bonus rate on total Medicare allowed charges for the 2009 calendar year, up from the 1.5% bonus previously offered under the program. CMS has also added documentation to the breast and colon measures (#99 and #100, respectively,) stating that independent laboratories using indicator place of service 81 are not included in the PQRI program. Information regarding the measures can be downloaded from the CMS website at: 2009 PQRI Quality Measure Specifications Manual and Release Notes [ZIP 1MB]. Open the document entitled, "2009 Physician Quality Reporting Initiative Measure Specifications Manual for Claims and Registry." Pages 211-216 provide an overview of the breast and colon pathology measures.