Friday, June 11, 2010

Physician Quality Reporting Initiative (PQRI) Modifiers

Physician Quality Reporting Initiative (PQRI) Modifiers

Performance Measure Exclusion Modifiers indicate that an action specified in the measure was not provided due to medical, patient, or system reason(s) documented in the medical record. Performance measure exclusion modifiers fall into one of three categories:

1P Performance Measure Exclusion Modifier due to Medical Reasons:
Includes: Not Indicated (absence of organ/limb, already received/performed, other); Contraindicated (patient allergic history, potential adverse drug interaction, other)
2P Performance Measure Exclusion Modifier due to Patient Reasons:
Includes: patient declined; economic, social, or religious reasons; other patient reasons
3P Performance Measure Exclusion Modifier due to System Reasons:Includes:
Resources to perform the services not available; insurance coverage/payer-related limitations; other reasons attributable to health care delivery system. Performance Measure Reporting Modifier:
Facilitates reporting a case when the patient is eligible but an action described in a measure is not performed and the reason is not specified or documented.
8P Performance Measure Reporting Modifier - Action not performed, reason not otherwise specified.

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