PQRS Measure
#117Dilated Eye Exam in Diabetic Patient
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 2022F | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM) | ||
| 2022F | 8P | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM) | |
| 2024F | 7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM) | ||
| 2024F | 8P | 7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM) | |
| 2026F | Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy (DM) | ||
| 2026F | 8P | Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy (DM) | |
| 3072F | Low risk for retinopathy (no evidence of retinopathy in the prior year) (DM) | ||
| 92002 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient | ||
| 92004 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits | ||
| 92012 | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient | ||
| 92014 | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits | ||
| 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. | ||
| 99217 | Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.]) | ||
| 99218 | Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. 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 problem(s) requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99219 | Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. 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 problem(s) requiring admission to outpatient hospital "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99220 | Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. 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 problem(s) requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99241 | Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and 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, 15 minutes are spent face-to-face with the patient and/or family. | ||
| 99242 | Office or other outpatient consultation for a new or 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, 20 minutes must be met or exceeded. | ||
| 99243 | Office or other outpatient consultation for a new or 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, 30 minutes must be met or exceeded. | ||
| 99244 | Office or other outpatient consultation for a new or 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, 40 minutes must be met or exceeded. | ||
| 99245 | Office or other outpatient consultation for a new or 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, 55 minutes must be met or exceeded. | ||
| 99455 | Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report. | ||
| 99456 | Work related or medical disability examination by other than the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report. | ||
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 250.00 | Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled | ||
| 250.01 | Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled | ||
| 250.02 | Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled | ||
| 250.03 | Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled | ||
| 250.10 | Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled | ||
| 250.11 | Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled | ||
| 250.12 | Diabetes with ketoacidosis, type II or unspecified type, uncontrolled | ||
| 250.13 | Diabetes with ketoacidosis, type I [juvenile type], uncontrolled | ||
| 250.20 | Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled | ||
| 250.21 | Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled | ||
| 250.22 | Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled | ||
| 250.23 | Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled | ||
| 250.30 | Diabetes with other coma, type II or unspecified type, not stated as uncontrolled | ||
| 250.31 | Diabetes with other coma, type I [juvenile type], not stated as uncontrolled | ||
| 250.32 | Diabetes with other coma, type II or unspecified type, uncontrolled | ||
| 250.33 | Diabetes with other coma, type I [juvenile type], uncontrolled | ||
| 250.40 | Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled | ||
| 250.41 | Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled | ||
| 250.42 | Diabetes with renal manifestations, type II or unspecified type, uncontrolled | ||
| 250.43 | Diabetes with renal manifestations, type I [juvenile type], uncontrolled | ||
| 250.50 | Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled | ||
| 250.51 | Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled | ||
| 250.52 | Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled | ||
| 250.53 | Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled | ||
| 250.60 | Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled | ||
| 250.61 | Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled | ||
| 250.62 | Diabetes with neurological manifestations, type II or unspecified type, uncontrolled | ||
| 250.63 | Diabetes with neurological manifestations, type I [juvenile type], uncontrolled | ||
| 250.70 | Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled | ||
| 250.71 | Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled | ||
| 250.72 | Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled | ||
| 250.73 | Diabetes with peripheral circulatory disorders, type I [juvenile type], uncontrolled | ||
| 250.80 | Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled | ||
| 250.81 | Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled | ||
| 250.82 | Diabetes with other specified manifestations, type II or unspecified type, uncontrolled | ||
| 250.83 | Diabetes with other specified manifestations, type I [juvenile type], uncontrolled | ||
| 250.90 | Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled | ||
| 250.91 | Diabetes with unspecified complication, type I [juvenile type], not stated as uncontrolled | ||
| 250.92 | Diabetes with unspecified complication, type II or unspecified type, uncontrolled | ||
| 250.93 | Diabetes with unspecified complication, type I [juvenile type], uncontrolled | ||
| 357.2 | Polyneuropathy in diabetes | ||
| 362.01 | Background diabetic retinopathy | ||
| 362.02 | Proliferative diabetic retinopathy | ||
| 362.03 | Nonproliferative diabetic retinopathy NOS | ||
| 362.04 | Mild nonproliferative diabetic retinopathy | ||
| 362.05 | Moderate nonproliferative diabetic retinopathy | ||
| 362.06 | Severe nonproliferative diabetic retinopathy | ||
| 362.07 | Diabetic macular edema | ||
| 366.41 | Diabetic cataract | ||
| 648.00 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable | ||
| 648.01 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition | ||
| 648.02 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication | ||
| 648.03 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication | ||
| 648.04 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication | ||
Legend:
Registry OKThis measure can be submitted through registry.
EHR OKThis measure can be submitted via Electronic Health Record (EHR).
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
Registry OKThis measure can be submitted through registry.
EHR OKThis measure can be submitted via Electronic Health Record (EHR).
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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