PQRS Measure
Report via: Claim, Registry
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 92002 | N/A | N/A | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient |
| 92004 | N/A | N/A | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits |
| 92012 | N/A | N/A | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient |
| 92014 | N/A | N/A | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits |
| 99201 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 99307 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 3284F | N/A | N/A | Intraocular pressure (IOP) reduced by a value of greater than or equal to 15% from the pre-intervention level (EC) |
| 0517F | 8P | N/A | Glaucoma plan of care documented (EC) |
| 0517F | N/A | N/A | Glaucoma plan of care documented (EC) |
| 3285F | N/A | N/A | Intraocular pressure (IOP) reduced by a value less than 15% from the pre-intervention level (EC) |
| 3284F | 8P | N/A | Intraocular pressure (IOP) reduced by a value of greater than or equal to 15% from the pre-intervention level (EC) |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 365.10 | N/A | N/A | Open-angle glaucoma, unspecified |
| 365.11 | N/A | N/A | Primary open angle glaucoma |
| 365.12 | N/A | N/A | Low tension open-angle glaucoma |
| 365.15 | N/A | N/A | Residual stage of open angle glaucoma |
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| H40.10X0 | N/A | N/A | Unspecified open-angle glaucoma, stage unspecified |
| H40.10X1 | N/A | N/A | Unspecified open-angle glaucoma, mild stage |
| H40.10X2 | N/A | N/A | Unspecified open-angle glaucoma, moderate stage |
| H40.10X3 | N/A | N/A | Unspecified open-angle glaucoma, severe stage |
| H40.10X4 | N/A | N/A | Unspecified open-angle glaucoma, indeterminate stage |
| H40.11X0 | N/A | N/A | Primary open-angle glaucoma, stage unspecified |
| H40.11X1 | N/A | N/A | Primary open-angle glaucoma, mild stage |
| H40.11X2 | N/A | N/A | Primary open-angle glaucoma, moderate stage |
| H40.11X3 | N/A | N/A | Primary open-angle glaucoma, severe stage |
| H40.11X4 | N/A | N/A | Primary open-angle glaucoma, indeterminate stage |
| H40.1210 | N/A | N/A | Low-tension glaucoma, right eye, stage unspecified |
| H40.1211 | N/A | N/A | Low-tension glaucoma, right eye, mild stage |
| H40.1212 | N/A | N/A | Low-tension glaucoma, right eye, moderate stage |
| H40.1213 | N/A | N/A | Low-tension glaucoma, right eye, severe stage |
| H40.1214 | N/A | N/A | Low-tension glaucoma, right eye, indeterminate stage |
| H40.1220 | N/A | N/A | Low-tension glaucoma, left eye, stage unspecified |
| H40.1221 | N/A | N/A | Low-tension glaucoma, left eye, mild stage |
| H40.1222 | N/A | N/A | Low-tension glaucoma, left eye, moderate stage |
| H40.1223 | N/A | N/A | Low-tension glaucoma, left eye, severe stage |
| H40.1224 | N/A | N/A | Low-tension glaucoma, left eye, indeterminate stage |
| H40.1230 | N/A | N/A | Low-tension glaucoma, bilateral, stage unspecified |
| H40.1231 | N/A | N/A | Low-tension glaucoma, bilateral, mild stage |
| H40.1232 | N/A | N/A | Low-tension glaucoma, bilateral, moderate stage |
| H40.1233 | N/A | N/A | Low-tension glaucoma, bilateral, severe stage |
| H40.1234 | N/A | N/A | Low-tension glaucoma, bilateral, indeterminate stage |
| H40.1290 | N/A | N/A | Low-tension glaucoma, unspecified eye, stage unspecified |
| H40.1291 | N/A | N/A | Low-tension glaucoma, unspecified eye, mild stage |
| H40.1292 | N/A | N/A | Low-tension glaucoma, unspecified eye, moderate stage |
| H40.1293 | N/A | N/A | Low-tension glaucoma, unspecified eye, severe stage |
| H40.1294 | N/A | N/A | Low-tension glaucoma, unspecified eye, indeterminate stage |
| H40.1510 | N/A | N/A | Residual stage of open-angle glaucoma, right eye, stage unspecified |
| H40.1511 | N/A | N/A | Residual stage of open-angle glaucoma, right eye, mild stage |
| H40.1512 | N/A | N/A | Residual stage of open-angle glaucoma, right eye, moderate stage |
| H40.1513 | N/A | N/A | Residual stage of open-angle glaucoma, right eye, severe stage |
| H40.1514 | N/A | N/A | Residual stage of open-angle glaucoma, right eye, indeterminate stage |
| H40.1520 | N/A | N/A | Residual stage of open-angle glaucoma, left eye, stage unspecified |
| H40.1521 | N/A | N/A | Residual stage of open-angle glaucoma, left eye, mild stage |
| H40.1522 | N/A | N/A | Residual stage of open-angle glaucoma, left eye, moderate stage |
| H40.1523 | N/A | N/A | Residual stage of open-angle glaucoma, left eye, severe stage |
| H40.1524 | N/A | N/A | Residual stage of open-angle glaucoma, left eye, indeterminate stage |
| H40.1530 | N/A | N/A | Residual stage of open-angle glaucoma, bilateral, stage unspecified |
| H40.1531 | N/A | N/A | Residual stage of open-angle glaucoma, bilateral, mild stage |
| H40.1532 | N/A | N/A | Residual stage of open-angle glaucoma, bilateral, moderate stage |
| H40.1533 | N/A | N/A | Residual stage of open-angle glaucoma, bilateral, severe stage |
| H40.1534 | N/A | N/A | Residual stage of open-angle glaucoma, bilateral, indeterminate stage |
| H40.1590 | N/A | N/A | Residual stage of open-angle glaucoma, unspecified eye, stage unspecified |
| H40.1591 | N/A | N/A | Residual stage of open-angle glaucoma, unspecified eye, mild stage |
| H40.1592 | N/A | N/A | Residual stage of open-angle glaucoma, unspecified eye, moderate stage |
| H40.1593 | N/A | N/A | Residual stage of open-angle glaucoma, unspecified eye, severe stage |
| H40.1594 | N/A | N/A | Residual stage of open-angle glaucoma, unspecified eye, indeterminate stage |
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).
GPRO/ACOThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
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).
GPRO/ACOThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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