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May 30, 2008

2008

May 30, 2008

HEADLINE

OMB Reverses Grant Approval Requirement Decision

Earlier this month, the Office of Management and Budget (OMB) issued a revised determination on the Centers for Disease Control and Prevention's (CDC) Tuberculosis Epidemiological Studies Consortium (TBESC) required compliance with the Paperwork Reduction Act. In April, CDC announced that TBESC grantees would need OMB review and approval of all grants, which would have caused a major delay in the consortium's operation. In response ATS and TBESC grantee concerns about the impact of the new requirement and a review of the TBESC's history, however, OMB came to the understanding that the activities under the program are granted exemption from compliance with the Paperwork Reduction Act. On May 13, OMB issued a revised determination clarifying that OMB Clearance will not be required for TBESC grantee task orders.

CLINCAL PRACTICE

There is Still Time to Participate in PQRI

There is still time to participate in physician quality reporting initiative (PQRI) for 2008 if you begin reporting by July 1, 2008. A half-year alternative reporting period has been designated as reporting July 1, 2008 through December 31, 2008. There is no enrollment. Participation starts by reporting the performance measure codes on claims forms for the relevant patients along with the relevant diagnosis and E/M codes noted on the list below. Performance measures cannot be reported by themselves on a claim form. There are a total of 60 of the 119 performance measures that only need to be reported once per patient per reporting period and qualify for the half-year 1.5% bonus of all Part B Medicare payments. Performance measure codes must be reported on a claim form for services between July 1 and December 31, 2008. For pulmonary, there are 4 of these 60 performance measures that only need to be reported once in a reporting period, two for COPD (#51 and #52) and two for Asthma (#53 and #64), noted in the table below. Specifications of these measures are detailed on the CMS website and are available through the link: www.cms.hhs.gov/pqri under measures and codes for 2008. 

PM# Descriptor CPT II Code CPT II Modifiers* ICD-9-CM Diagnosis Codes CPT Evaluation and Management (E/M) Codes
51 COPD: Spirometry Evaluation Aged 18 and older 3023F 1P, 2P, 3P, 8P 491.0, 491.1, 491.20, 491.21, 491.22, 491.8, 491.9, 492.0, 492.8, 496 99201-99205, 99212-99215, 99241-99245
52 COPD: Bronchodilator Rx Aged 18 and older 4025F + 3025F 1P, 2P, 3P, 8P to 4025F + 3025F or 3027F 491.0, 491.1, 491.20, 491.21, 491.22, 491.8, 491.9, 492.0, 492.8, 496 99201-99205, 99212-99215, 99241-99245
53 Asthma: Pharmacologic Therapy Aged 5-40 4015F + 1038F 4015F-2P or 1038F-8P or 1039F-8P 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91, 493.92 99201-99205, 99212-99215, 99241-99245
64 Asthma Assessment Aged 5-40 1005F 1005-8P 493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91, 493.92 99201-99205, 99212-99215, 99241-99245

CPT II Performance Measure Codes COPD:

3023F Spirometry results documented and reviewed
3025F Spirometry test results demonstrate FEV1/FVC < 70% with COPD symptoms (eg, dyspnea, cough/sputum, wheezing)
3027F Spirometry test results demonstrate FEV1/FVC > or equal to 70% or patient does not have COPD symptoms
4025F Inhaled bronchodilator prescribed

ASTHMA:

1005F Asthma symptoms evaluated (includes physician documentation of numeric frequency of symptoms or patient completion of an asthma assessment tool/survey/questionnaire)
1038F Persistent asthma (mild, moderate or severe)
4015F Persistent asthma, preferred long-term control medication or acceptable alternative treatment prescribed

CPT II Modifiers*

1P: Performance Measures Exclusion Modifier due to Medical Reasons
2P: Performance Measures Exclusion Modifier due to Patient Reasons
3P: Performance Measures Exclusion Modifier due to System Reasons
8P: Performance Measure Reporting Modifier - action not performed, reason not otherwise specified

If you have questions or need additional information, please feel free to contact the ATS Washington Office at (advocacy@thoracic.org).

PHYSICIAN SUPPLY

House Passes Conrad 30 Physician Visa Waiver Program Bill

IN May, the House of Representative passed legislation to extend and expand the Conrad 30 physician J-1 visa waiver program. The bill passed by the House reauthorizes the program through 2013. Additionally, the bill expands 10 the number of visa waivers states can issue to non-primary care to serve in areas outside of federally determined physician shortage areas.

Parallel legislation has been offered in the Senate and will likely be considered by the Senate this summer.



Points of Contact

Gary Ewart Senior Director, Government Relations
Nuala Moore Senior Legislative Representative
Joe Kirby DC Office Administrator