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PQRS Measure

#204Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
 Description  Data Collection Sheet  Coding Specifications Report via: Claim, Registry, GPRO II, Measure Group
 This measure is can be reported as part of the following groups:
 Ischemic Vascular Disease (IVD) Group   

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
99201Office 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.
99202Office 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.
99203Office 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.
99204Office 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.
99205Office 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.
99211Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional
99212Office 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.
99213Office 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.
99214Office 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.
99215Office 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.
99217Observation 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.])
99218Initial 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.
99219Initial 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.
99220Initial 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.
99341Home 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.
99342Home 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.
99343Home 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.
99344Home 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.
99345Home 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.
99347Home 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.
99348Home 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.
99349Home 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.
99350Home 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.
99455Work 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.
99456Work 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.
33510Coronary artery bypass, vein only; single coronary venous graft
33511Coronary artery bypass, vein only; 2 coronary venous grafts
33512Coronary artery bypass, vein only; 3 coronary venous grafts
33513Coronary artery bypass, vein only; 4 coronary venous grafts
33514Coronary artery bypass, vein only; 5 coronary venous grafts
33516Coronary artery bypass, vein only; 6 or more coronary venous grafts
33517Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure)
33518Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure)
33519Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (List separately in addition to code for primary procedure)
33521Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (List separately in addition to code for primary procedure)
33522Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (List separately in addition to code for primary procedure)
33523Coronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (List separately in addition to code for primary procedure)
33533Coronary artery bypass, using arterial graft(s); single arterial graft
33534Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts
33535Coronary artery bypass, using arterial graft(s); 3 coronary arterial grafts
33536Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts
33140Transmyocardial laser revascularization, by thoracotomy; (separate procedure)
92980Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
92982Percutaneous transluminal coronary balloon angioplasty; single vessel
92995Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel

HCPCS Codes

CodeModifierPOSDescription
G8598Aspirin or another antiplatelet therapy used
G8599Aspirin or another antiplatelet therapy not used, reason not given

ICD9 Codes

CodeModifierPOSDescription
410.11Acute myocardial infarction of other anterior wall, initial episode of care
410.21Acute myocardial infarction of inferolateral wall, initial episode of care
410.31Acute myocardial infarction of inferoposterior wall, initial episode of care
410.41Acute myocardial infarction of other inferior wall, initial episode of care
410.51Acute myocardial infarction of other lateral wall, initial episode of care
410.61True posterior wall infarction, initial episode of care
410.71Subendocardial infarction, initial episode of care
410.81Acute myocardial infarction of other specified sites, initial episode of care
410.91Acute myocardial infarction of unspecified site, initial episode of care
411.0Postmyocardial infarction syndrome
411.1Intermediate coronary syndrome
411.81Acute coronary occlusion without myocardial infarction
411.89Other acute and subacute forms of ischemic heart disease, other
413.0Angina decubitus
413.1Prinzmetal angina
413.9Other and unspecified angina pectoris
414.00Coronary atherosclerosis of unspecified type of vessel, native or graft
414.01Coronary atherosclerosis of native coronary artery
414.02Coronary atherosclerosis of autologous vein bypass graft
414.03Coronary atherosclerosis of nonautologous biological bypass graft
414.04Coronary atherosclerosis of artery bypass graft
414.05Coronary atherosclerosis of unspecified bypass graft
414.06Coronary atherosclerosis of native coronary artery of transplanted heart
414.07Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
414.8Other specified forms of chronic ischemic heart disease
414.9Chronic ischemic heart disease, unspecified
429.2Cardiovascular disease, unspecified
433.00Occlusion and stenosis of basilar artery without mention of cerebral infarction
433.01Occlusion and stenosis of basilar artery with cerebral infarction
433.10Occlusion and stenosis of carotid artery without mention of cerebral infarction
433.11Occlusion and stenosis of carotid artery with cerebral infarction
433.20Occlusion and stenosis of vertebral artery without mention of cerebral infarction
433.21Occlusion and stenosis of vertebral artery with cerebral infarction
433.30Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction
433.31Occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction
433.80Occlusion and stenosis of other specified precerebral artery without mention of cerebral infarction
433.81Occlusion and stenosis of other specified precerebral artery with cerebral infarction
433.90Occlusion and stenosis of unspecified precerebral artery without mention of cerebral infarction
433.91Occlusion and stenosis of unspecified precerebral artery with cerebral infarction
434.00Cerebral thrombosis without mention of cerebral infarction
434.01Cerebral thrombosis with cerebral infarction
434.10Cerebral embolism without mention of cerebral infarction
434.11Cerebral embolism with cerebral infarction
434.90Cerebral artery occlusion, unspecified without mention of cerebral infarction
434.91Cerebral artery occlusion, unspecified with cerebral infarction
440.1Atherosclerosis of renal artery
440.20Atherosclerosis of native arteries of the extremities, unspecified
440.21Atherosclerosis of native arteries of the extremities with intermittent claudication
440.22Atherosclerosis of native arteries of the extremities with rest pain
440.23Atherosclerosis of native arteries of the extremities with ulceration
440.24Atherosclerosis of native arteries of the extremities with gangrene
440.29Other atherosclerosis of native arteries of the extremities
440.4Chronic total occlusion of artery of the extremities
444.0Arterial embolism and thrombosis of abdominal aorta
444.1Embolism and thrombosis of thoracic aorta
444.21Arterial embolism and thrombosis of upper extremity
444.22Arterial embolism and thrombosis of lower extremity
444.81Embolism and thrombosis of iliac artery
444.89Embolism and thrombosis of other specified artery
444.9Embolism and thrombosis of unspecified artery
445.01Atheroembolism of upper extremity
445.02Atheroembolism of lower extremity
445.81Atheroembolism of kidney
445.89Atheroembolism of other site
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 IThis measure can be submitted via Group Practice Reporting Option 1.
GPRO IIThis measure can be submitted via Group Practice Reporting Option 2.

More information on these alternative reporting mechanisms is available at:
    http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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