Following is a step-by-step basic guide for psychologists participating in PQRS for the first
time in 2013.
Step 1 Determine which PQRS reporting
method is appropriate for your practice.
Although eligible professionals may choose from
several methods for submitting PQRS data, most
psychologists will use claims-based reporting.
This option simply involves reporting measures
on the standard CMS-1500 claim form. Other
options for PQRS reporting include registry-based, qualified Electronic Health Record (EHR),
or a Group Practice Reporting Option (GPRO).
Check the CMS website at go.cms.gov/Vkaa8V
for information about the latter three options.
Step 2 Select a measure.
Review the list of 2013 PQRS measures on the
next page that psychologists are eligible to report
and determine which ones match the services
you provide. CMS recommends reporting on at
least three measures, but you can report just one
or two measures if fewer than three measures
apply to your practice. (The reporting period for
2013 is 12 months, January 1 – December 31.)
of the PQRS Measures Specifications Manual
would be 90791: Psychiatric Diagnostic Evaluation.
Step 4 Use the appropriate G-code to indicate
whether the service was performed or why it
was not performed.
Quality codes, or G-codes, are used to indicate
what action, if any, you took. G-codes can be
found on the measures worksheets. Because
PQRS is a reporting program rather than a
pay-for-performance program, health care
professionals may indicate they did not provide
the action specified under the measure and still
qualify for bonus payments in 2013.
For example, for Measure 181: Elder Maltreatment
Screen, if the Elder Maltreatment Screen is
documented as negative and no follow-up plan
is required, G-code G8734 would be reported
along with the procedure code.
Both the procedure code and the G-code must
be reported on the same CMS-1500 claim form.
Step 5 Record the information on the CMS-
1500 claim form.
The information noted below must be reported
on the claim form (see page 4 for an example).
Step 3 Check the measures worksheets in
order to determine the required procedure codes.
Measure worksheets are found in the 2013 PQRS
Measures Specifications Manual, available in
the related links section of the Measures Codes
page at go.cms.gov/UmysQS. The procedure
code is the CPT® code for the service provided.
Be sure to use the new CPT codes for 2013 that
took effect on Jan. 1. For example, if in Step 2
a psychologist selected Measure 181: Elder
Maltreatment Screen and Follow-Up Plan, an
acceptable procedure code as listed on page 386
Current Procedural Terminology (CPT®) copyright 2011
American Medical Association. All rights reserved.
Line 1 Dates of service: Record when the service
Line 1 Procedures, services or supplies: Use the
procedure code from Step 3.
Line 1 Charges: List your charge for this service.
Quality reporting information
Line 2 Dates of service: Record the same
information as above – when the service was
Line 2 Procedures, services, or supplies: Use the
applicable quality code (For example: G8534).
Line 2 Charges: List 0.00 (or 0.01 if your
software will not accept 0.00) on this line.