clinical social work association

The majority of LCSWs are choosing to submit the Quality Data Codes (QDCs) for PQRS Measures on the CMS-1500 claim forms.  The primary change is to add the QDC(s) in Section 24D under the CPT code and add $.00 or $.01 in Section 24F on the same line.  For a sample CMS-1500 with PQRS data go to http://www.facs.org/ahp/pqri/2013/cms-1500-claim.pdf .  This is for surgeons, so ignore the diagnoses, but most of the other information is the same (except for Section 24J for group billing which does not apply to LCSWs in private practice which should be left blank). 

Many LCSWs have been stymied by the fact that there is so little correlation between the PQRS measures and our diagnostic codes (DSM/ICD).  The only measures that mention a diagnostic code are #106 and #107 for major depression.  However, ALL diagnostic codes we use can be linked with whether people smoke, drink, use substances and several other behaviors that CMS is tracking.  Use the QDCs that apply to them if you are sending in information for other diagnoses, which you can find on the CSWA website at www.clinicalsocialworkassociation.org under "Clinical Practice" and then "PQRS Options".  Scroll down to find the PQRS Measures and QDCs for those Measures.   

There is NO deadline today for LCSWs who send in their QDCs on the CMS-1500.  You can wait until February 28, 2014 to do so, though getting it out of the way sooner is a good idea.  You should continue to send QDCs for Medicare patients on every claim.    

Remember, for 2013, you only need send in one QDC for one patient to be in compliance and avoid a reimbursement penalty in 2015.  It is unlikely that you will qualify for the bonus in 2015 unless you have been sending in QDCs all year OR you have very few Medicare patients. 

I know what a difficult task this has been and hope that this information is useful in navigating these rough waters.