Healthcare Training: Category II Codes Quality Measures


Each Category II Codes have a number. Number 20 is the Preoperative Antibiotics. And the category II codes would be 4047F, 4048F. Notice that these are five items alphanumeric codes with the last item, the letter F. Know more about these codes in this expert information provided by our speaker in a medical billing and coding training conference.

Thromboembolism prophylaxis. Number 47 Advanced Care Plan. Number 48 Urinary Incontinence, number 49 Urinary Incontinence, the characterization of that incontinence, and number 50 Urinary Incontinence, the formation of a plan of care. Number 102 Prostate cancer, the avoidance of over use of bone scan for staging low-risk prostate cancer. This is a new code. It's 3270F and 3271F.

Then, we have number 104 Prostate cancer quality measure. This is Adjuvant hormonal therapy for high-risk prostate cancer patients, 4164F. That’s a new code. 105, Cancer of the Prostate, a 3D radiotherapy program like an IMRT. And you have your category II code which are new. We have a category II code number 114, Preventive care and screening. And this is when the urologist makes an inquiry regarding tobacco use. And as you can see, you have four category II medical coding and billing reporting options.

G Codes and Further Category II Codes

Again, quality measures that the urologist may find helpful for reporting quality measures. Measurement 115 preventive care and screening: advising smokers to quit. You can see there's a G code and then two alphanumeric codes. Number 124 quality measure health information technology adoption and use of an EHR. And you have a couple of G codes. And the last one we are going to mention is 130 for urology. You may want to look at this one for documentation and verification of current various medications documented in the medical records.

Number 73 is the Plan of chemotherapy documented before chemotherapy was administered. And then we have two codes that pertain to urology, the appropriate initial evaluation of patient with prostate cancer and 103 review of treatment options in patients with clinically localized prostatic cancer. These codes are no longer available. Now, they also dropped and discontinued code 125, the e-prescribing planning. But there is now a separate and new bonus format for reporting e-prescribing. And that is available to the physicians not in the physician quality reporting initiative.

Medical Coding Training Tip: Claims based reporting is probably the most common. And we're going to look at some principles. When you use the CPT category II code are codes or G code or code, this numerator must be reported on the same claim form or electronic form that you are billing for payment for clinical services. And we'll see that in a moment.

It must be for the same beneficiary. And it must be on the same – all on the same date of service. And for the urologist, the same urologist and he will need his NPI and TIN number applied. And remember all diagnoses on the base claim will be included in the CMS PQRS analysis not just the diagnosis for the line item for the quality measure but all diagnosis reported in box 21. This will help the urologist satisfy the requirements for the use of these quality measures.

When reporting quality data codes, and they're abbreviated QDC on the 1500 form or an electronic equivalent, the submitted charge field, that would be box 24F on the 1500 form or the equivalent electronic submission cannot be left blank. The line item charge for quality measures or as we now call them quality data code, the charge should be $0.00.

Now, there are some computer software program that will not allow a $0.00 charge. Under those circumstances, make the charge $0.01. The total submitted charge for the claim cannot be zero dollars. That is you cannot resubmit or submit a claim only for QDC medical codes. But the QDC codes must be on a claim again that we've said it several times in which you are charging or you're billing for reimbursement for a clinical service using CPT1 code or codes.

Also remember that for submission and acceptance of the quality data codes, the forms must include the NPI number and the TIN number of the physician and his office.

The quality data medical codes are reportable again, on the Part B claims which are being submitted for clinical payment and reimbursement for clinical services. And payment is going to be made under the under the allowable Medicare Physician Fee Schedules, the PFS charges.

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