PQRS Information

Year: 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007

PQRS Measure

#161HIV/AIDS: Adolescent and Adult Patients with HIV/AIDS Who Are Prescribed Potent Antiretroviral Therapy

Report via: Registry, Measure Group

This measure is can be reported as part of the following groups:
• HIV/AIDS Group

The following codes apply for this PQRS measure:

Code	Modifier	POS	Description
CPT Codes
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.
4276F	N/A	N/A	Potent antiretroviral therapy prescribed (HIV)
3492F	N/A	N/A	History of nadir CD4+ cell count <350 cells/mm3 (HIV)
3490F	N/A	N/A	History of AIDS-defining condition (HIV)
4276F	8P	N/A	Potent antiretroviral therapy prescribed (HIV)
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.
4276F	N/A	N/A	Potent antiretroviral therapy prescribed (HIV)
4276F	8P	N/A	Potent antiretroviral therapy prescribed (HIV)
HCPCS Codes
Code	Modifier	POS	Description
G0402	N/A	N/A	Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
G0402	N/A	N/A	Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
ICD9 Codes
Code	Modifier	POS	Description
042	N/A	N/A	Human immunodeficiency virus [HIV] disease
V08	N/A	N/A	Asymptomatic human immunodeficiency virus [HIV] infection status
042	N/A	N/A	Human immunodeficiency virus [HIV] disease
V08	N/A	N/A	Asymptomatic human immunodeficiency virus [HIV] infection status
V22.0	N/A	N/A	Supervision of normal first pregnancy
V22.1	N/A	N/A	Supervision of other normal pregnancy
V22.2	N/A	N/A	Pregnant state, incidental
V23.0	N/A	N/A	Supervision of high-risk pregnancy with history of infertility
V23.1	N/A	N/A	Supervision of high-risk pregnancy with history of trophoblastic disease
V23.2	N/A	N/A	Supervision of high-risk pregnancy with history of abortion
V23.3	N/A	N/A	Supervision of high-risk pregnancy with grand multiparity
V23.41	N/A	N/A	Pregnancy with history of pre-term labor
V23.42	N/A	N/A	Pregnancy with history of ectopic pregnancy
V23.49	N/A	N/A	Pregnancy with other poor obstetric history
V23.5	N/A	N/A	Supervision of high-risk pregnancy with other poor reproductive history
V23.7	N/A	N/A	Supervision of high-risk pregnancy with insufficient prenatal care
V23.81	N/A	N/A	Supervision of high-risk pregnancy with elderly primigravida
V23.82	N/A	N/A	Supervision of high-risk pregnancy with elderly multigravida
V23.83	N/A	N/A	Supervision of high-risk pregnancy with young primigravida
V23.84	N/A	N/A	Supervision of high-risk pregnancy with young multigravida
V23.87	N/A	N/A	Pregnancy with inconclusive fetal viability
V23.89	N/A	N/A	Supervision of other high-risk pregnancy
V23.9	N/A	N/A	Supervision of unspecified high-risk pregnancy
ICD10CM Codes
Code	Modifier	POS	Description
Z21	N/A	N/A	Asymptomatic human immunodeficiency virus [HIV] infection status
B20	N/A	N/A	Human immunodeficiency virus [HIV] disease
Z21	N/A	N/A	Asymptomatic human immunodeficiency virus [HIV] infection status
B20	N/A	N/A	Human immunodeficiency virus [HIV] disease
O09.00	N/A	N/A	Supervision of pregnancy with history of infertility, unspecified trimester
O09.01	N/A	N/A	Supervision of pregnancy with history of infertility, first trimester
O09.02	N/A	N/A	Supervision of pregnancy with history of infertility, second trimester
O09.03	N/A	N/A	Supervision of pregnancy with history of infertility, third trimester
O09.10	N/A	N/A	Supervision of pregnancy with history of ectopic pregnancy, unspecified trimester
O09.11	N/A	N/A	Supervision of pregnancy with history of ectopic pregnancy, first trimester
O09.12	N/A	N/A	Supervision of pregnancy with history of ectopic pregnancy, second trimester
O09.13	N/A	N/A	Supervision of pregnancy with history of ectopic pregnancy, third trimester
O09.211	N/A	N/A	Supervision of pregnancy with history of pre-term labor, first trimester
O09.212	N/A	N/A	Supervision of pregnancy with history of pre-term labor, second trimester
O09.213	N/A	N/A	Supervision of pregnancy with history of pre-term labor, third trimester
O09.219	N/A	N/A	Supervision of pregnancy with history of pre-term labor, unspecified trimester
O09.291	N/A	N/A	Supervision of pregnancy with other poor reproductive or obstetric history, first trimester
O09.292	N/A	N/A	Supervision of pregnancy with other poor reproductive or obstetric history, second trimester
O09.293	N/A	N/A	Supervision of pregnancy with other poor reproductive or obstetric history, third trimester
O09.299	N/A	N/A	Supervision of pregnancy with other poor reproductive or obstetric history, unspecified trimester
O09.30	N/A	N/A	Supervision of pregnancy with insufficient antenatal care, unspecified trimester
O09.31	N/A	N/A	Supervision of pregnancy with insufficient antenatal care, first trimester
O09.32	N/A	N/A	Supervision of pregnancy with insufficient antenatal care, second trimester
O09.33	N/A	N/A	Supervision of pregnancy with insufficient antenatal care, third trimester
O09.40	N/A	N/A	Supervision of pregnancy with grand multiparity, unspecified trimester
O09.41	N/A	N/A	Supervision of pregnancy with grand multiparity, first trimester
O09.42	N/A	N/A	Supervision of pregnancy with grand multiparity, second trimester
O09.43	N/A	N/A	Supervision of pregnancy with grand multiparity, third trimester
O09.511	N/A	N/A	Supervision of elderly primigravida, first trimester
O09.512	N/A	N/A	Supervision of elderly primigravida, second trimester
O09.513	N/A	N/A	Supervision of elderly primigravida, third trimester
O09.519	N/A	N/A	Supervision of elderly primigravida, unspecified trimester
O09.521	N/A	N/A	Supervision of elderly multigravida, first trimester
O09.522	N/A	N/A	Supervision of elderly multigravida, second trimester
O09.523	N/A	N/A	Supervision of elderly multigravida, third trimester
O09.529	N/A	N/A	Supervision of elderly multigravida, unspecified trimester
O09.611	N/A	N/A	Supervision of young primigravida, first trimester
O09.612	N/A	N/A	Supervision of young primigravida, second trimester
O09.613	N/A	N/A	Supervision of young primigravida, third trimester
O09.619	N/A	N/A	Supervision of young primigravida, unspecified trimester
O09.621	N/A	N/A	Supervision of young multigravida, first trimester
O09.622	N/A	N/A	Supervision of young multigravida, second trimester
O09.623	N/A	N/A	Supervision of young multigravida, third trimester
O09.629	N/A	N/A	Supervision of young multigravida, unspecified trimester
O09.70	N/A	N/A	Supervision of high risk pregnancy due to social problems, unspecified trimester
O09.71	N/A	N/A	Supervision of high risk pregnancy due to social problems, first trimester
O09.72	N/A	N/A	Supervision of high risk pregnancy due to social problems, second trimester
O09.73	N/A	N/A	Supervision of high risk pregnancy due to social problems, third trimester
O09.811	N/A	N/A	Supervision of pregnancy resulting from assisted reproductive technology, first trimester
O09.812	N/A	N/A	Supervision of pregnancy resulting from assisted reproductive technology, second trimester
O09.813	N/A	N/A	Supervision of pregnancy resulting from assisted reproductive technology, third trimester
O09.819	N/A	N/A	Supervision of pregnancy resulting from assisted reproductive technology, unspecified trimester
O09.821	N/A	N/A	Supervision of pregnancy with history of in utero procedure during previous pregnancy, first trimester
O09.822	N/A	N/A	Supervision of pregnancy with history of in utero procedure during previous pregnancy, second trimester
O09.823	N/A	N/A	Supervision of pregnancy with history of in utero procedure during previous pregnancy, third trimester
O09.829	N/A	N/A	Supervision of pregnancy with history of in utero procedure during previous pregnancy, unspecified trimester
O09.891	N/A	N/A	Supervision of other high risk pregnancies, first trimester
O09.892	N/A	N/A	Supervision of other high risk pregnancies, second trimester
O09.893	N/A	N/A	Supervision of other high risk pregnancies, third trimester
O09.899	N/A	N/A	Supervision of other high risk pregnancies, unspecified trimester
O09.90	N/A	N/A	Supervision of high risk pregnancy, unspecified, unspecified trimester
O09.91	N/A	N/A	Supervision of high risk pregnancy, unspecified, first trimester
O09.92	N/A	N/A	Supervision of high risk pregnancy, unspecified, second trimester
O09.93	N/A	N/A	Supervision of high risk pregnancy, unspecified, third trimester
O36.80X0	N/A	N/A	Pregnancy with inconclusive fetal viability, not applicable or unspecified
O36.80X1	N/A	N/A	Pregnancy with inconclusive fetal viability, fetus 1
O36.80X2	N/A	N/A	Pregnancy with inconclusive fetal viability, fetus 2
O36.80X3	N/A	N/A	Pregnancy with inconclusive fetal viability, fetus 3
O36.80X4	N/A	N/A	Pregnancy with inconclusive fetal viability, fetus 4
O36.80X5	N/A	N/A	Pregnancy with inconclusive fetal viability, fetus 5
O36.80X9	N/A	N/A	Pregnancy with inconclusive fetal viability, other fetus
Z33.1	N/A	N/A	Pregnant state, incidental
Z34.00	N/A	N/A	Encounter for supervision of normal first pregnancy, unspecified trimester
Z34.01	N/A	N/A	Encounter for supervision of normal first pregnancy, first trimester
Z34.02	N/A	N/A	Encounter for supervision of normal first pregnancy, second trimester
Z34.03	N/A	N/A	Encounter for supervision of normal first pregnancy, third trimester
Z34.80	N/A	N/A	Encounter for supervision of other normal pregnancy, unspecified trimester
Z34.81	N/A	N/A	Encounter for supervision of other normal pregnancy, first trimester
Z34.82	N/A	N/A	Encounter for supervision of other normal pregnancy, second trimester
Z34.83	N/A	N/A	Encounter for supervision of other normal pregnancy, third trimester
Z34.90	N/A	N/A	Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
Z34.91	N/A	N/A	Encounter for supervision of normal pregnancy, unspecified, first trimester
Z34.92	N/A	N/A	Encounter for supervision of normal pregnancy, unspecified, second trimester
Z34.93	N/A	N/A	Encounter for supervision of normal pregnancy, unspecified, third trimester
Z36	N/A	N/A	Encounter for antenatal screening of mother

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.

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