PQRS Measure
This measure may be submitted via Registry only
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 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. | ||
| 99221 | Initial hospital inpatient or observation 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 medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | ||
| 99222 | Initial hospital inpatient or observation 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, 55 minutes must be met or exceeded. | ||
| 99223 | Initial hospital inpatient or observation 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, 75 minutes must be met or exceeded. | ||
| 99224 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; 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 patient is stable, recovering, or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99225 | Subsequent observation care, per day, for the evaluation and management of a 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 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 patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99226 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; 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 complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99231 | Subsequent hospital inpatient or observation 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. | ||
| 99232 | Subsequent hospital inpatient or observation 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. | ||
| 99233 | Subsequent hospital inpatient or observation 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. | ||
| 99281 | Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional | ||
| 99282 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making | ||
| 99283 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making | ||
| 99284 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making | ||
| 99285 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making | ||
| 99291 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8600 | Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well | ||
| G8601 | Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention) | ||
| G8602 | Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given | ||
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 433.01 | Occlusion and stenosis of basilar artery with cerebral infarction | ||
| 433.10 | Occlusion and stenosis of carotid artery without mention of cerebral infarction | ||
| 433.11 | Occlusion and stenosis of carotid artery with cerebral infarction | ||
| 433.21 | Occlusion and stenosis of vertebral artery with cerebral infarction | ||
| 433.31 | Occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction | ||
| 433.81 | Occlusion and stenosis of other specified precerebral artery with cerebral infarction | ||
| 433.91 | Occlusion and stenosis of unspecified precerebral artery with cerebral infarction | ||
| 434.00 | Cerebral thrombosis without mention of cerebral infarction | ||
| 434.01 | Cerebral thrombosis with cerebral infarction | ||
| 434.11 | Cerebral embolism with cerebral infarction | ||
| 434.91 | Cerebral artery occlusion, unspecified with cerebral infarction | ||
| 436 | Acute, but ill-defined, cerebrovascular disease | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| I63.111 | Cerebral infarction due to embolism of right vertebral artery | ||
| I63.112 | Cerebral infarction due to embolism of left vertebral artery | ||
| I63.119 | Cerebral infarction due to embolism of unspecified vertebral artery | ||
| I63.139 | Cerebral infarction due to embolism of unspecified carotid artery | ||
| I63.19 | Cerebral infarction due to embolism of other precerebral artery | ||
| I63.20 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries | ||
| I63.219 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery | ||
| I63.22 | Cerebral infarction due to unspecified occlusion or stenosis of basilar artery | ||
| I63.231 | Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries | ||
| I63.232 | Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries | ||
| I63.239 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery | ||
| I63.30 | Cerebral infarction due to thrombosis of unspecified cerebral artery | ||
| I63.40 | Cerebral infarction due to embolism of unspecified cerebral artery | ||
| I63.50 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery | ||
| I63.59 | Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery | ||
| I65.29 | Occlusion and stenosis of unspecified carotid artery | ||
| I66.02 | Occlusion and stenosis of left middle cerebral artery | ||
| I66.03 | Occlusion and stenosis of bilateral middle cerebral arteries | ||
| I66.09 | Occlusion and stenosis of unspecified middle cerebral artery | ||
| I66.19 | Occlusion and stenosis of unspecified anterior cerebral artery | ||
| I66.29 | Occlusion and stenosis of unspecified posterior cerebral artery | ||
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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