PQRS Measure
#117Diabetes Mellitus: Dilated 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) | ||
| 2024F | 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) | ||
| 3072F | Low risk for retinopathy (no evidence of retinopathy in the prior year) (DM) | ||
| 2022F | 8P | Dilated retinal eye exam 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 | 8P | Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy (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 | ||
| 97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | ||
| 97803 | Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes | ||
| 97804 | Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes | ||
| 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. | ||
| 99304 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. | ||
| 99305 | Initial nursing facility care, per day, for the evaluation and management of a 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, 35 minutes must be met or exceeded. | ||
| 99306 | Initial nursing facility care, per day, for the evaluation and management of a 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, 50 minutes must be met or exceeded. | ||
| 99307 | Subsequent nursing facility care, per day, for the evaluation and management of a 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. | ||
| 99308 | Subsequent nursing facility care, per day, for the evaluation and management of a 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. | ||
| 99309 | Subsequent nursing facility care, per day, for the evaluation and management of a 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. | ||
| 99310 | Subsequent nursing facility care, per day, for the evaluation and management of a 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, 45 minutes must be met or exceeded. | ||
| 99324 | Domiciliary or rest home visit for the evaluation and management of a new 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 of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver. | ||
| 99325 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making 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 presenting problem(s) are of moderate severity. Typically, 30 minutes are spent with the patient and/or family or caregiver. | ||
| 99326 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed 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 presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver. | ||
| 99327 | Domiciliary or rest home visit for the evaluation and management of a new 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 presenting problem(s) are of high severity. Typically, 60 minutes are spent with the patient and/or family or caregiver. | ||
| 99328 | Domiciliary or rest home visit for the evaluation and management of a new 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 patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver. | ||
| 99334 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval 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, 15 minutes are spent with the patient and/or family or caregiver. | ||
| 99335 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making 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 presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver. | ||
| 99336 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; 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 presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver. | ||
| 99337 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to 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 presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver. | ||
| 99341 | Home or residence 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. | ||
| 99342 | Home or residence 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. | ||
| 99343 | Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed 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 presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. | ||
| 99344 | Home or residence 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, 60 minutes must be met or exceeded. | ||
| 99345 | Home or residence 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, 75 minutes must be met or exceeded. | ||
| 99347 | Home or residence 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, 20 minutes must be met or exceeded. | ||
| 99348 | Home or residence 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, 30 minutes must be met or exceeded. | ||
| 99349 | Home or residence 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, 40 minutes must be met or exceeded. | ||
| 99350 | Home or residence 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, 60 minutes must be met or exceeded. | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G0270 | Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes | ||
| G0271 | Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes | ||
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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