PQRS Measure
This measure may be submitted via Registry only
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 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. | ||
| 3319F | 1 of the following diagnostic imaging studies ordered: chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (ML) | ||
| 3319F | 1P | 1 of the following diagnostic imaging studies ordered: chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (ML) | |
| 3319F | 3P | 1 of the following diagnostic imaging studies ordered: chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (ML) | |
| 3320F | None of the following diagnostic imaging studies ordered: chest X-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (ML) | ||
| 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. | ||
| 3319F | 1 of the following diagnostic imaging studies ordered: chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (ML) | ||
| 3319F | 1P | 1 of the following diagnostic imaging studies ordered: chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (ML) | |
| 3319F | 3P | 1 of the following diagnostic imaging studies ordered: chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (ML) | |
| 3320F | None of the following diagnostic imaging studies ordered: chest X-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (ML) | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8944 | Ajcc melanoma cancer stage 0 through iic melanoma | ||
| G8749 | Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma) | ||
| G8749 | Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma) | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| C43.0 | Malignant melanoma of lip | ||
| C43.10 | Malignant melanoma of unspecified eyelid, including canthus | ||
| C43.11 | Malignant melanoma of right eyelid, including canthus | ||
| C43.12 | Malignant melanoma of left eyelid, including canthus | ||
| C43.20 | Malignant melanoma of unspecified ear and external auricular canal | ||
| C43.21 | Malignant melanoma of right ear and external auricular canal | ||
| C43.22 | Malignant melanoma of left ear and external auricular canal | ||
| C43.30 | Malignant melanoma of unspecified part of face | ||
| C43.31 | Malignant melanoma of nose | ||
| C43.39 | Malignant melanoma of other parts of face | ||
| C43.4 | Malignant melanoma of scalp and neck | ||
| C43.51 | Malignant melanoma of anal skin | ||
| C43.52 | Malignant melanoma of skin of breast | ||
| C43.59 | Malignant melanoma of other part of trunk | ||
| C43.60 | Malignant melanoma of unspecified upper limb, including shoulder | ||
| C43.61 | Malignant melanoma of right upper limb, including shoulder | ||
| C43.62 | Malignant melanoma of left upper limb, including shoulder | ||
| C43.70 | Malignant melanoma of unspecified lower limb, including hip | ||
| C43.71 | Malignant melanoma of right lower limb, including hip | ||
| C43.72 | Malignant melanoma of left lower limb, including hip | ||
| C43.8 | Malignant melanoma of overlapping sites of skin | ||
| C43.9 | Malignant melanoma of skin, unspecified | ||
| D03.0 | Melanoma in situ of lip | ||
| D03.10 | Melanoma in situ of unspecified eyelid, including canthus | ||
| D03.11 | Melanoma in situ of right eyelid, including canthus | ||
| D03.12 | Melanoma in situ of left eyelid, including canthus | ||
| D03.20 | Melanoma in situ of unspecified ear and external auricular canal | ||
| D03.21 | Melanoma in situ of right ear and external auricular canal | ||
| D03.22 | Melanoma in situ of left ear and external auricular canal | ||
| D03.30 | Melanoma in situ of unspecified part of face | ||
| D03.39 | Melanoma in situ of other parts of face | ||
| D03.4 | Melanoma in situ of scalp and neck | ||
| D03.51 | Melanoma in situ of anal skin | ||
| D03.52 | Melanoma in situ of breast (skin) (soft tissue) | ||
| D03.59 | Melanoma in situ of other part of trunk | ||
| D03.60 | Melanoma in situ of unspecified upper limb, including shoulder | ||
| D03.61 | Melanoma in situ of right upper limb, including shoulder | ||
| D03.62 | Melanoma in situ of left upper limb, including shoulder | ||
| D03.70 | Melanoma in situ of unspecified lower limb, including hip | ||
| D03.71 | Melanoma in situ of right lower limb, including hip | ||
| D03.72 | Melanoma in situ of left lower limb, including hip | ||
| D03.8 | Melanoma in situ of other sites | ||
| D03.9 | Melanoma in situ, unspecified | ||
| Z85.820 | Personal history of malignant melanoma of skin | ||
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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