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Perioperative Care
Selection of Prophylactic Antibiotic — First OR Second Generation Cephalosporin
This measure is to be reported each time a surgical procedure with the indications for a first or second
generation cephalosporin antibiotic is performed during the reporting period.
Measure description
What if this process or outcome of care is not
Percentage of surgical patients aged 18 years and older undergoing appropriate for your patient?
procedures with the indications for a first OR second generation There may be times when it is not appropriate to order a first or cephalosporin prophylactic antibiotic, who had an order for second generation cephalosporin antibiotic, due to: cefazolin OR cefuroxime for antimicrobial prophylaxis n Medical reasons (eg, not indicated, contraindicated, other What will you need to report for each patient
In these cases, you will need to indicate that the medical undergoing a surgical procedure with the indications reason applies, specify the reason on the worksheet and in
for a first or second generation cephalosporin
the medical chart. The office/billing staff will then report antibiotic for this measure?
a code with a modifier that represents these valid reasons If you select this measure for reporting, you will report: n Whether or not there was an order1 for cefazolin or cefuroxime for antimicrobial prophylaxis OR n Whether or not cefazolin or cefuroxime was given for 1 There must be documentation of order (written order, verbal order, or standing order/protocol) for cefazolin or cefuroxime for antimicrobial prophylaxis OR documentation that cefazolin or cefuroxime was given.
PQRI 2007 Measure 21, Effective Date 07/01/2007 2004–6 American Medical Association and National Committee for Quality Assurance. All rights reserved. (Disclaimers, Copyright and other Notices indicated on the Coding Specifications document are incorporated by reference) Perioperative Care
Selection of Prophylactic Antibiotic — First OR Second Generation Cephalosporin
PQRI Data Collection Sheet
Clinical Information
Billing Information
Step 1 Is patient eligible for this measure?
Code Required on Claim Form
Refer to coding specifications document for list of applicable codes.
If No is checked for any of the above, STOP. Do not report
a CPT category II code.
Step 2 Does patient meet or have an acceptable reason
for not meeting the measure?
Code to be Reported on Line 24D of Paper Claim Form,
Cefazolin OR Cefuroxime
if Yes (or Service Line 24 of Electronic Claim Form)
Not ordered or given for the following reason:• Medical (eg, not indicated, contraindicated, Document reason here and in medical chart.
If No is checked for all of the above, report
4041F–8P
(Order for cefazolin OR cefuroxime for
antimicrobial prophylaxis was not documented,
reason not otherwise specified.)
1 There must be documentation of order (written order, verbal order, or standing order/protocol) for cefazolin or cefuroxime for antimicrobial prophylaxis OR documentation that cefazolin or PQRI 2007 Measure 21, Effective Date 07/01/2007 2004–06 American Medical Association and National Committee for Quality Assurance. (Disclaimers, Copyright and other Notices indicated on the Coding Specifications document are incorporated by reference) CPT® copyright 2006 American Medical Association.
Perioperative Care
Selection of Prophylactic Antibiotic — First OR Second Generation Cephalosporin
Coding Specifications
n 48001, 48020, 48100, 48102, 48120, 48140, 48145, 48146, Codes required to document a surgical procedure for which a 48148, 48150, 48152, 48153, 48154, 48155, 48160, 48500, first or second generation cephalosporin prophylactic antibiotic 48510, 48511, 48520, 48540, 48545, 48547, 48548, 48550, n 49000, 49002, 49010, 49180, 49200, 49201, 49215 (abdomen, A CPT procedure code is required to identify patients to be n 50300, 50320, 50340, 50360, 50365, 50370, 50380 CPT procedure codes
n 58150, 58152, 58180, 58200, 58210, 58260, 58262, 58263, n 15734, 15738, 19260, 19271, 19272, 19301, 19302, 19303, 19304, 19305, 19306, 19307, 19361, 19364, 19366, 19367, 19368, 19369 58267, 58270, 58275, 58280, 58285, 58290, 58291, 58292, n 22524, 22554, 22558, 22600, 22612, 22630, 35301, 61154, n 22325, 22612, 22630, 22800, 22802, 22804, 63030, 63042 61312, 61313, 61315, 61510, 61512, 61518, 61548, 61697, 61700, 61750, 61751, 61867, 62223, 62230, 63015, 63020, n 27125, 27130, 27132, 27134, 27137, 27138 63030, 63042, 63045, 63047, 63056, 63075, 63081, 63267, n 27235, 27236, 27244, 27245, 27758, 27759, 27766, 27792, n 33120, 33130, 33140, 33141, 33202, 33250, 33251, 33256, 33261, 33300, 33305, 33310, 33315, 33320, 33321, 33322, n 27440, 27441, 27442, 27443, 27445, 27446, 27447 33332, 33335, 33400, 33401, 33403, 33404, 33405, 33406, 33410, 33411, 33413, 33416, 33422, 33425, 33426, 33427, n 33877, 33880, 33881, 33883, 33886, 33891, 34800, 34802, 34803, 33430, 33460, 33463, 33464, 33465, 33475, 33496, 33510, 34804, 34805, 34825, 34830, 34831, 34832, 34900, 35081, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 35091, 35102, 35131, 35141, 35151, 35601, 35606, 35612, 35616, 33522, 33523, 33530, 33533, 33534, 33535, 33536, 33542, 35621, 35623, 35626, 35631, 35636, 35637, 35638, 35642, 35645, 33545, 33548, 33572, 35021, 35211, 35216, 35241, 35246, 35646, 35647, 35650, 35651, 35654, 35656, 35661, 35663, 35271, 35276, 35311, 35820 (cardiothoracic surgery), 35665, 35666, 35671, 36830 (vascular surgery), n 33203, 33254, 33255 (cardiothoracic surgery (pacemaker)), n 38100, 38101, 38115, 38120 (spleen and lymph nodes surgery), n 19272, 21627, 21632, 21740, 21750, 21805, 21825, 31760, n 43045, 43100, 43101, 43107, 43108, 43112, 43113, 43116, 31766, 31770, 31775, 31786, 31805, 32035, 32036, 32095, 43117, 43118, 43121, 43122, 43123, 43124, 43130, 43135, 32100, 32110, 32120, 32124, 32140, 32141, 32150, 32200, 43280, 43300, 43305, 43310, 43312, 43313, 43320, 43324, 32215, 32220, 32225, 32310, 32320, 32402, 32440, 32442, 43325, 43326, 43330, 43331, 43340, 43341, 43350, 43351, 32445, 32480, 32482, 32484, 32486, 32488, 32491, 32500, 43352, 43360, 43361, 43400, 43401, 43405, 43410, 43415, 32501, 32540, 32601, 32602, 32603, 32604, 32605, 32606, 32650, 32651, 32652, 32653, 32654, 32655, 32656, 32657, 32658, 32659, 32660, 32661, 32662, 32663, 32664, 32665, n 43500, 43501, 43502, 43510, 43520, 43600, 43605, 43610, 43611, 43620, 43621, 43622, 43631, 43632, 43633, 43634, 32800, 32810, 32815, 32900, 32905, 32906, 32940, 33020, 43640, 43641, 43651, 43652, 43653, 43800, 43810, 43820, 33025, 33030, 33031, 33050, 33300, 33310, 33320, 34051, 43825, 43830, 43831, 43832, 43840, 43842, 43843, 43845, 35021, 35216, 35246, 35276, 35311, 35481, 35526, 37616, 43846, 48347, 43848, 43850, 43855, 43860, 43865, 43870, 38381, 38746, 38747, 39000, 39010, 39200, 39220, 39545, 39561, 60521, 60522, 64746 (general thoracic surgery) n 27702, 27703, 27704, 27870, 28192, 28193, 28293, 28296, n 44005, 44010, 44020, 44021, 44025, 44050, 44055, 44100, 44110, 44111, 44120, 44125, 44126, 44127, 44130, 44132, 28299, 28300, 28306, 28307, 28308, 28309, 28310, 28320, 44133, 44135, 44136 (small intestine surgery), 28322, 28415, 28420, 28445, 28465, 28485, 28505, 28525, 28531, 28555, 28585, 28615, 28645, 28675, 28705, 28715, n 47133, 47135, 47136, 47140, 47141, 47142 (hepatic surgery), 28725, 28730, 28735, 28737, 28740, 28750, 28755, 28760 n 47420, 47425, 47460, 47480, 47490, 47510, 47511, 47525, 47530, 47560, 47561, 47570, 47600, 47605, 47610, 47612, 47620, 47630, 47700, 47701, 47711, 47712, 47715, 47719, 47720, 47721, 47740, 47741, 47760, 47765, 47780, 47785, Perioperative Care
Selection of Prophylactic Antibiotic — First OR Second Generation Cephalosporin
Quality codes for this measure (one of the following for every CPT II Code descriptors
(Data Collection sheet should be used to determine appropriate
combination of codes.)
n CPT II 4041F: Documentation of order for cefazolin
OR cefuroxime for antimicrobial prophylaxis (Note: CPT Category II code 4041F is provided for antibiotic ordered or antibiotic given. Report CPT Category II code 4041F if cefazolin OR cefuroxime was given for n CPT II 4041F–1P: Documentation of medical
reason(s) for not ordering cefazolin OR cefuroxime n CPT II 4041F–8P: Order for cefazolin OR cefuroxime
for antimicrobial prophylaxis was not documented, reason Physician Performance Measures (Measures) and related data specifications, developed by the American Medical Association (AMA) in col aboration with the Physician Consortium for Performance Improvement (the Consortium) and the National Committee for Quality Assurance (NCQA) pursuant to government sponsorship under subcontract 6205-05-054 with Mathematica Policy Research, Inc. under contract 500-00-0033 with Centers for Medicare & Medicaid Services.
These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the Consortium) or NCQA. Neither the AMA, NCQA, Consortium nor its members shall be responsible for any use of the Measures.
THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
2004–6 American Medical Association and National Committee for Quality Assurance. All Rights Reserved.
Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, NCQA, the Consortium and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.
CPT® contained in the Measures specifications is copyright 2006 American Medical Association G codes and associated descriptions included in these Measure specifications are in the public domain.
PQRI 2007 Measure 21, Effective Date 07/01/2007 2004–6 American Medical Association and National Committee for Quality Assurance. All Rights Reserved. CPT® copyright 2006 American Medical Association

Source: http://members.sirweb.org/members/coding/PerformanceMeasureWorksheets/PQRIMeasure21.pdf