PQRS Measure
Report via: Claim, Registry
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 99201 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. | ||
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. | ||
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | ||
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | ||
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | ||
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. | ||
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | ||
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | ||
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | ||
| 1006F | Osteoarthritis symptoms and functional status assessed (may include the use of a standardized scale or the completion of an assessment questionnaire, such as the SF-36, AAOS Hip & Knee Questionnaire) (OA) [Instructions: Report when osteoarthritis is addressed during the patient encounter] | ||
| 1006F | 8P | Osteoarthritis symptoms and functional status assessed (may include the use of a standardized scale or the completion of an assessment questionnaire, such as the SF-36, AAOS Hip & Knee Questionnaire) (OA) [Instructions: Report when osteoarthritis is addressed during the patient encounter] | |
| 1006F | Osteoarthritis symptoms and functional status assessed (may include the use of a standardized scale or the completion of an assessment questionnaire, such as the SF-36, AAOS Hip & Knee Questionnaire) (OA) [Instructions: Report when osteoarthritis is addressed during the patient encounter] | ||
| 1006F | 8P | Osteoarthritis symptoms and functional status assessed (may include the use of a standardized scale or the completion of an assessment questionnaire, such as the SF-36, AAOS Hip & Knee Questionnaire) (OA) [Instructions: Report when osteoarthritis is addressed during the patient encounter] | |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 715.00 | Osteoarthrosis, generalized, site unspecified | ||
| 715.04 | Osteoarthrosis, generalized, hand | ||
| 715.09 | Osteoarthrosis, generalized, multiple sites | ||
| 715.10 | Osteoarthrosis, localized, primary, site unspecified | ||
| 715.11 | Osteoarthrosis, localized, primary, shoulder region | ||
| 715.12 | Osteoarthrosis, localized, primary, upper arm | ||
| 715.13 | Osteoarthrosis, localized, primary, forearm | ||
| 715.14 | Osteoarthrosis, localized, primary, hand | ||
| 715.15 | Osteoarthrosis, localized, primary, pelvic region and thigh | ||
| 715.16 | Osteoarthrosis, localized, primary, lower leg | ||
| 715.17 | Osteoarthrosis, localized, primary, ankle and foot | ||
| 715.18 | Osteoarthrosis, localized, primary, other specified sites | ||
| 715.20 | Osteoarthrosis, localized, secondary, site unspecified | ||
| 715.21 | Osteoarthrosis, localized, secondary, shoulder region | ||
| 715.22 | Osteoarthrosis, localized, secondary, upper arm | ||
| 715.23 | Osteoarthrosis, localized, secondary, forearm | ||
| 715.24 | Osteoarthrosis, localized, secondary, hand | ||
| 715.25 | Osteoarthrosis, localized, secondary, pelvic region and thigh | ||
| 715.26 | Osteoarthrosis, localized, secondary, lower leg | ||
| 715.27 | Osteoarthrosis, localized, secondary, ankle and foot | ||
| 715.28 | Osteoarthrosis, localized, secondary, other specified sites | ||
| 715.30 | Osteoarthrosis, localized, not specified whether primary or secondary, site unspecified | ||
| 715.31 | Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region | ||
| 715.32 | Osteoarthrosis, localized, not specified whether primary or secondary, upper arm | ||
| 715.33 | Osteoarthrosis, localized, not specified whether primary or secondary, forearm | ||
| 715.34 | Osteoarthrosis, localized, not specified whether primary or secondary, hand | ||
| 715.35 | Osteoarthrosis, localized, not specified whether primary or secondary, pelvic region and thigh | ||
| 715.36 | Osteoarthrosis, localized, not specified whether primary or secondary, lower leg | ||
| 715.37 | Osteoarthrosis, localized, not specified whether primary or secondary, ankle and foot | ||
| 715.38 | Osteoarthrosis, localized, not specified whether primary or secondary, other specified sites | ||
| 715.80 | Osteoarthrosis involving, or with mention of more than one site, but not specified as generalized, site unspecified | ||
| 715.89 | Osteoarthrosis involving, or with mention of more than one site, but not specified as generalized, multiple sites | ||
| 715.90 | Osteoarthrosis, unspecified whether generalized or localized, site unspecified | ||
| 715.91 | Osteoarthrosis, unspecified whether generalized or localized, shoulder region | ||
| 715.92 | Osteoarthrosis, unspecified whether generalized or localized, upper arm | ||
| 715.93 | Osteoarthrosis, unspecified whether generalized or localized, forearm | ||
| 715.94 | Osteoarthrosis, unspecified whether generalized or localized, hand | ||
| 715.95 | Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh | ||
| 715.96 | Osteoarthrosis, unspecified whether generalized or localized, lower leg | ||
| 715.97 | Osteoarthrosis, unspecified whether generalized or localized, ankle and foot | ||
| 715.98 | Osteoarthrosis, unspecified whether generalized or localized, other specified sites | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| M15.0 | Primary generalized (osteo)arthritis | ||
| M15.1 | Heberden's nodes (with arthropathy) | ||
| M15.2 | Bouchard's nodes (with arthropathy) | ||
| M15.3 | Secondary multiple arthritis | ||
| M15.4 | Erosive (osteo)arthritis | ||
| M15.8 | Other polyosteoarthritis | ||
| M15.9 | Polyosteoarthritis, unspecified | ||
| M16.0 | Bilateral primary osteoarthritis of hip | ||
| M16.10 | Unilateral primary osteoarthritis, unspecified hip | ||
| M16.11 | Unilateral primary osteoarthritis, right hip | ||
| M16.12 | Unilateral primary osteoarthritis, left hip | ||
| M16.2 | Bilateral osteoarthritis resulting from hip dysplasia | ||
| M16.30 | Unilateral osteoarthritis resulting from hip dysplasia, unspecified hip | ||
| M16.31 | Unilateral osteoarthritis resulting from hip dysplasia, right hip | ||
| M16.32 | Unilateral osteoarthritis resulting from hip dysplasia, left hip | ||
| M16.4 | Bilateral post-traumatic osteoarthritis of hip | ||
| M16.50 | Unilateral post-traumatic osteoarthritis, unspecified hip | ||
| M16.51 | Unilateral post-traumatic osteoarthritis, right hip | ||
| M16.52 | Unilateral post-traumatic osteoarthritis, left hip | ||
| M16.6 | Other bilateral secondary osteoarthritis of hip | ||
| M16.7 | Other unilateral secondary osteoarthritis of hip | ||
| M16.9 | Osteoarthritis of hip, unspecified | ||
| M17.0 | Bilateral primary osteoarthritis of knee | ||
| M17.10 | Unilateral primary osteoarthritis, unspecified knee | ||
| M17.11 | Unilateral primary osteoarthritis, right knee | ||
| M17.12 | Unilateral primary osteoarthritis, left knee | ||
| M17.2 | Bilateral post-traumatic osteoarthritis of knee | ||
| M17.30 | Unilateral post-traumatic osteoarthritis, unspecified knee | ||
| M17.31 | Unilateral post-traumatic osteoarthritis, right knee | ||
| M17.32 | Unilateral post-traumatic osteoarthritis, left knee | ||
| M17.4 | Other bilateral secondary osteoarthritis of knee | ||
| M17.5 | Other unilateral secondary osteoarthritis of knee | ||
| M17.9 | Osteoarthritis of knee, unspecified | ||
| M18.0 | Bilateral primary osteoarthritis of first carpometacarpal joints | ||
| M18.10 | Unilateral primary osteoarthritis of first carpometacarpal joint, unspecified hand | ||
| M18.11 | Unilateral primary osteoarthritis of first carpometacarpal joint, right hand | ||
| M18.12 | Unilateral primary osteoarthritis of first carpometacarpal joint, left hand | ||
| M18.2 | Bilateral post-traumatic osteoarthritis of first carpometacarpal joints | ||
| M18.30 | Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, unspecified hand | ||
| M18.31 | Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, right hand | ||
| M18.32 | Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, left hand | ||
| M18.4 | Other bilateral secondary osteoarthritis of first carpometacarpal joints | ||
| M18.50 | Other unilateral secondary osteoarthritis of first carpometacarpal joint, unspecified hand | ||
| M18.51 | Other unilateral secondary osteoarthritis of first carpometacarpal joint, right hand | ||
| M18.52 | Other unilateral secondary osteoarthritis of first carpometacarpal joint, left hand | ||
| M18.9 | Osteoarthritis of first carpometacarpal joint, unspecified | ||
| M19.011 | Primary osteoarthritis, right shoulder | ||
| M19.012 | Primary osteoarthritis, left shoulder | ||
| M19.019 | Primary osteoarthritis, unspecified shoulder | ||
| M19.021 | Primary osteoarthritis, right elbow | ||
| M19.022 | Primary osteoarthritis, left elbow | ||
| M19.029 | Primary osteoarthritis, unspecified elbow | ||
| M19.031 | Primary osteoarthritis, right wrist | ||
| M19.032 | Primary osteoarthritis, left wrist | ||
| M19.039 | Primary osteoarthritis, unspecified wrist | ||
| M19.041 | Primary osteoarthritis, right hand | ||
| M19.042 | Primary osteoarthritis, left hand | ||
| M19.049 | Primary osteoarthritis, unspecified hand | ||
| M19.071 | Primary osteoarthritis, right ankle and foot | ||
| M19.072 | Primary osteoarthritis, left ankle and foot | ||
| M19.079 | Primary osteoarthritis, unspecified ankle and foot | ||
| M19.111 | Post-traumatic osteoarthritis, right shoulder | ||
| M19.112 | Post-traumatic osteoarthritis, left shoulder | ||
| M19.119 | Post-traumatic osteoarthritis, unspecified shoulder | ||
| M19.121 | Post-traumatic osteoarthritis, right elbow | ||
| M19.122 | Post-traumatic osteoarthritis, left elbow | ||
| M19.129 | Post-traumatic osteoarthritis, unspecified elbow | ||
| M19.131 | Post-traumatic osteoarthritis, right wrist | ||
| M19.132 | Post-traumatic osteoarthritis, left wrist | ||
| M19.139 | Post-traumatic osteoarthritis, unspecified wrist | ||
| M19.141 | Post-traumatic osteoarthritis, right hand | ||
| M19.142 | Post-traumatic osteoarthritis, left hand | ||
| M19.149 | Post-traumatic osteoarthritis, unspecified hand | ||
| M19.171 | Post-traumatic osteoarthritis, right ankle and foot | ||
| M19.172 | Post-traumatic osteoarthritis, left ankle and foot | ||
| M19.179 | Post-traumatic osteoarthritis, unspecified ankle and foot | ||
| M19.211 | Secondary osteoarthritis, right shoulder | ||
| M19.212 | Secondary osteoarthritis, left shoulder | ||
| M19.219 | Secondary osteoarthritis, unspecified shoulder | ||
| M19.221 | Secondary osteoarthritis, right elbow | ||
| M19.222 | Secondary osteoarthritis, left elbow | ||
| M19.229 | Secondary osteoarthritis, unspecified elbow | ||
| M19.231 | Secondary osteoarthritis, right wrist | ||
| M19.232 | Secondary osteoarthritis, left wrist | ||
| M19.239 | Secondary osteoarthritis, unspecified wrist | ||
| M19.241 | Secondary osteoarthritis, right hand | ||
| M19.242 | Secondary osteoarthritis, left hand | ||
| M19.249 | Secondary osteoarthritis, unspecified hand | ||
| M19.271 | Secondary osteoarthritis, right ankle and foot | ||
| M19.272 | Secondary osteoarthritis, left ankle and foot | ||
| M19.279 | Secondary osteoarthritis, unspecified ankle and foot | ||
| M19.90 | Unspecified osteoarthritis, unspecified site | ||
| M19.91 | Primary osteoarthritis, unspecified site | ||
| M19.92 | Post-traumatic osteoarthritis, unspecified site | ||
| M19.93 | Secondary osteoarthritis, unspecified site | ||
Legend:
ClaimThis measure can be submitted via claim. Use the 'Data Collection' pdf associated with the measure.
GroupThis measure can be submitted through one or more groups. Click on the group name to view the group information.
RegistryThis measure can be submitted through registry.
EHRThis measure can be submitted via Electronic Health Record (EHR).
GPROThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
SurveyThis measure can be submitted/collected via a Certified Survey Vendor.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
ClaimThis measure can be submitted via claim. Use the 'Data Collection' pdf associated with the measure.
GroupThis measure can be submitted through one or more groups. Click on the group name to view the group information.
RegistryThis measure can be submitted through registry.
EHRThis measure can be submitted via Electronic Health Record (EHR).
GPROThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
SurveyThis measure can be submitted/collected via a Certified Survey Vendor.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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