PQRS Measure
This measure may be submitted via Registry only
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 99221 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 99231 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 99238 | N/A | N/A | Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter |
| 99239 | N/A | N/A | Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter |
| 99291 | N/A | N/A | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8682 | N/A | N/A | Lvf testing documented as being performed prior to discharge or in the previous 12 months |
| G8683 | N/A | N/A | Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason |
| G8685 | N/A | N/A | Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 402.01 | N/A | N/A | Malignant hypertensive heart disease with heart failure |
| 402.11 | N/A | N/A | Benign hypertensive heart disease with heart failure |
| 402.91 | N/A | N/A | Unspecified hypertensive heart disease with heart failure |
| 404.01 | N/A | N/A | Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified |
| 404.03 | N/A | N/A | Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease |
| 404.11 | N/A | N/A | Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified |
| 404.13 | N/A | N/A | Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease |
| 404.91 | N/A | N/A | Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified |
| 404.93 | N/A | N/A | Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease |
| 428.0 | N/A | N/A | Congestive heart failure, unspecified |
| 428.1 | N/A | N/A | Left heart failure |
| 428.20 | N/A | N/A | Systolic heart failure, unspecified |
| 428.21 | N/A | N/A | Acute systolic heart failure |
| 428.22 | N/A | N/A | Chronic systolic heart failure |
| 428.23 | N/A | N/A | Acute on chronic systolic heart failure |
| 428.30 | N/A | N/A | Diastolic heart failure, unspecified |
| 428.31 | N/A | N/A | Acute diastolic heart failure |
| 428.32 | N/A | N/A | Chronic diastolic heart failure |
| 428.33 | N/A | N/A | Acute on chronic diastolic heart failure |
| 428.40 | N/A | N/A | Combined systolic and diastolic heart failure, unspecified |
| 428.41 | N/A | N/A | Acute combined systolic and diastolic heart failure |
| 428.42 | N/A | N/A | Chronic combined systolic and diastolic heart failure |
| 428.43 | N/A | N/A | Acute on chronic combined systolic and diastolic heart failure |
| 428.9 | N/A | N/A | Heart failure, unspecified |
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| I11.0 | N/A | N/A | Hypertensive heart disease with heart failure |
| I13.0 | N/A | N/A | Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease |
| I13.2 | N/A | N/A | Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease |
| I50.1 | N/A | N/A | Left ventricular failure, unspecified |
| I50.20 | N/A | N/A | Unspecified systolic (congestive) heart failure |
| I50.21 | N/A | N/A | Acute systolic (congestive) heart failure |
| I50.22 | N/A | N/A | Chronic systolic (congestive) heart failure |
| I50.23 | N/A | N/A | Acute on chronic systolic (congestive) heart failure |
| I50.30 | N/A | N/A | Unspecified diastolic (congestive) heart failure |
| I50.31 | N/A | N/A | Acute diastolic (congestive) heart failure |
| I50.32 | N/A | N/A | Chronic diastolic (congestive) heart failure |
| I50.33 | N/A | N/A | Acute on chronic diastolic (congestive) heart failure |
| I50.40 | N/A | N/A | Unspecified combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.41 | N/A | N/A | Acute combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.42 | N/A | N/A | Chronic combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.43 | N/A | N/A | Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.9 | N/A | N/A | Heart failure, unspecified |
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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