PQRS Measure
Report via: Claim, Registry, EHR, GPRO/ACO
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 time for code selection, 15-29 minutes of total time is spent on the date of the encounter. | ||
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 time for code selection, 30-44 minutes of total time is spent on the date of the encounter. | ||
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 time for code selection, 45-59 minutes of total time is spent on the date of the encounter. | ||
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 time for code selection, 60-74 minutes of total time is spent on the date of the encounter. | ||
99211 | Office 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 | ||
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 time for code selection, 10-19 minutes of total time is spent on the date of the encounter. | ||
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 time for code selection, 20-29 minutes of total time is spent on the date of the encounter. | ||
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 time for code selection, 30-39 minutes of total time is spent on the date of the encounter. | ||
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 time for code selection, 40-54 minutes of total time is spent on the date of the encounter. | ||
HCPCS Codes | |||
Code | Modifier | POS | Description |
G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | ||
G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | ||
G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | ||
G8752 | Most recent systolic blood pressure < 140 mmhg | ||
G8752 | Most recent systolic blood pressure < 140 mmhg | ||
G8752 | Most recent systolic blood pressure < 140 mmhg | ||
G8753 | Most recent systolic blood pressure >= 140 mmhg | ||
G8753 | Most recent systolic blood pressure >= 140 mmhg | ||
G8754 | Most recent diastolic blood pressure < 90 mmhg | ||
G8754 | Most recent diastolic blood pressure < 90 mmhg | ||
G8754 | Most recent diastolic blood pressure < 90 mmhg | ||
G8755 | Most recent diastolic blood pressure >= 90 mmhg | ||
G8755 | Most recent diastolic blood pressure >= 90 mmhg | ||
G8756 | No documentation of blood pressure measurement, reason not given | ||
G8756 | No documentation of blood pressure measurement, reason not given | ||
G9231 | Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period | ||
ICD9 Codes | |||
Code | Modifier | POS | Description |
401.0 | Malignant essential hypertension | ||
401.1 | Benign essential hypertension | ||
401.9 | Unspecified essential hypertension | ||
ICD10CM Codes | |||
Code | Modifier | POS | Description |
I10 | Essential (primary) hypertension |
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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