PQRS Measure
#241Ischemic Vascular Disease (IVD): Complete Lipid Panel and Low Density Lipoprotein (LDL-C) Control
Report via: Claim, Registry, EHR, GPRO I, Measure Group
This measure is can be reported as part of the following groups:
• Ischemic Vascular Disease (IVD) Group
• Cardiovascular Prevention Group
• Ischemic Vascular Disease (IVD) Group
• Cardiovascular Prevention Group
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 33140 | N/A | N/A | Transmyocardial laser revascularization, by thoracotomy; (separate procedure) |
| 33510 | N/A | N/A | Coronary artery bypass, vein only; single coronary venous graft |
| 33511 | N/A | N/A | Coronary artery bypass, vein only; 2 coronary venous grafts |
| 33512 | N/A | N/A | Coronary artery bypass, vein only; 3 coronary venous grafts |
| 33513 | N/A | N/A | Coronary artery bypass, vein only; 4 coronary venous grafts |
| 33514 | N/A | N/A | Coronary artery bypass, vein only; 5 coronary venous grafts |
| 33516 | N/A | N/A | Coronary artery bypass, vein only; 6 or more coronary venous grafts |
| 33517 | N/A | N/A | Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure) |
| 33518 | N/A | N/A | Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure) |
| 33519 | N/A | N/A | Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (List separately in addition to code for primary procedure) |
| 33521 | N/A | N/A | Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (List separately in addition to code for primary procedure) |
| 33522 | N/A | N/A | Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (List separately in addition to code for primary procedure) |
| 33523 | N/A | N/A | Coronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (List separately in addition to code for primary procedure) |
| 33533 | N/A | N/A | Coronary artery bypass, using arterial graft(s); single arterial graft |
| 33534 | N/A | N/A | Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts |
| 33535 | N/A | N/A | Coronary artery bypass, using arterial graft(s); 3 coronary arterial grafts |
| 33536 | N/A | N/A | Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts |
| 92980 | N/A | N/A | Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel |
| 92982 | N/A | N/A | Percutaneous transluminal coronary balloon angioplasty; single vessel |
| 92995 | N/A | N/A | Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty; single vessel |
| 99201 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 99211 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 99217 | N/A | N/A | Observation 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.]) |
| 99218 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 99341 | N/A | N/A | Home 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. |
| 99342 | N/A | N/A | Home 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. |
| 99343 | N/A | N/A | Home 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. |
| 99344 | N/A | N/A | Home 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. |
| 99345 | N/A | N/A | Home 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. |
| 99347 | N/A | N/A | Home 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. |
| 99348 | N/A | N/A | Home 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. |
| 99349 | N/A | N/A | Home 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. |
| 99350 | N/A | N/A | Home 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. |
| 99455 | N/A | N/A | Work 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. |
| 99456 | N/A | N/A | Work 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. |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8593 | N/A | N/A | Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) |
| G8594 | N/A | N/A | Lipid profile not performed, reason not given |
| G8595 | N/A | N/A | Most recent ldl-c < 100 mg/dl |
| G8597 | N/A | N/A | Most recent ldl-c >= 100 mg/dl |
| G8593 | N/A | N/A | Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) |
| G8594 | N/A | N/A | Lipid profile not performed, reason not given |
| G8595 | N/A | N/A | Most recent ldl-c < 100 mg/dl |
| G8597 | N/A | N/A | Most recent ldl-c >= 100 mg/dl |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 410.11 | N/A | N/A | Acute myocardial infarction of other anterior wall, initial episode of care |
| 410.21 | N/A | N/A | Acute myocardial infarction of inferolateral wall, initial episode of care |
| 410.31 | N/A | N/A | Acute myocardial infarction of inferoposterior wall, initial episode of care |
| 410.41 | N/A | N/A | Acute myocardial infarction of other inferior wall, initial episode of care |
| 410.51 | N/A | N/A | Acute myocardial infarction of other lateral wall, initial episode of care |
| 410.61 | N/A | N/A | True posterior wall infarction, initial episode of care |
| 410.71 | N/A | N/A | Subendocardial infarction, initial episode of care |
| 410.81 | N/A | N/A | Acute myocardial infarction of other specified sites, initial episode of care |
| 410.91 | N/A | N/A | Acute myocardial infarction of unspecified site, initial episode of care |
| 411.0 | N/A | N/A | Postmyocardial infarction syndrome |
| 411.1 | N/A | N/A | Intermediate coronary syndrome |
| 411.81 | N/A | N/A | Acute coronary occlusion without myocardial infarction |
| 411.89 | N/A | N/A | Other acute and subacute forms of ischemic heart disease, other |
| 413.0 | N/A | N/A | Angina decubitus |
| 413.1 | N/A | N/A | Prinzmetal angina |
| 413.9 | N/A | N/A | Other and unspecified angina pectoris |
| 414.00 | N/A | N/A | Coronary atherosclerosis of unspecified type of vessel, native or graft |
| 414.01 | N/A | N/A | Coronary atherosclerosis of native coronary artery |
| 414.02 | N/A | N/A | Coronary atherosclerosis of autologous vein bypass graft |
| 414.03 | N/A | N/A | Coronary atherosclerosis of nonautologous biological bypass graft |
| 414.04 | N/A | N/A | Coronary atherosclerosis of artery bypass graft |
| 414.05 | N/A | N/A | Coronary atherosclerosis of unspecified bypass graft |
| 414.06 | N/A | N/A | Coronary atherosclerosis of native coronary artery of transplanted heart |
| 414.07 | N/A | N/A | Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart |
| 414.2 | N/A | N/A | Chronic total occlusion of coronary artery |
| 414.8 | N/A | N/A | Other specified forms of chronic ischemic heart disease |
| 414.9 | N/A | N/A | Chronic ischemic heart disease, unspecified |
| 429.2 | N/A | N/A | Cardiovascular disease, unspecified |
| 433.00 | N/A | N/A | Occlusion and stenosis of basilar artery without mention of cerebral infarction |
| 433.01 | N/A | N/A | Occlusion and stenosis of basilar artery with cerebral infarction |
| 433.10 | N/A | N/A | Occlusion and stenosis of carotid artery without mention of cerebral infarction |
| 433.11 | N/A | N/A | Occlusion and stenosis of carotid artery with cerebral infarction |
| 433.20 | N/A | N/A | Occlusion and stenosis of vertebral artery without mention of cerebral infarction |
| 433.21 | N/A | N/A | Occlusion and stenosis of vertebral artery with cerebral infarction |
| 433.30 | N/A | N/A | Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction |
| 433.31 | N/A | N/A | Occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction |
| 433.80 | N/A | N/A | Occlusion and stenosis of other specified precerebral artery without mention of cerebral infarction |
| 433.81 | N/A | N/A | Occlusion and stenosis of other specified precerebral artery with cerebral infarction |
| 433.90 | N/A | N/A | Occlusion and stenosis of unspecified precerebral artery without mention of cerebral infarction |
| 433.91 | N/A | N/A | Occlusion and stenosis of unspecified precerebral artery with cerebral infarction |
| 434.00 | N/A | N/A | Cerebral thrombosis without mention of cerebral infarction |
| 434.01 | N/A | N/A | Cerebral thrombosis with cerebral infarction |
| 434.10 | N/A | N/A | Cerebral embolism without mention of cerebral infarction |
| 434.11 | N/A | N/A | Cerebral embolism with cerebral infarction |
| 434.90 | N/A | N/A | Cerebral artery occlusion, unspecified without mention of cerebral infarction |
| 434.91 | N/A | N/A | Cerebral artery occlusion, unspecified with cerebral infarction |
| 440.1 | N/A | N/A | Atherosclerosis of renal artery |
| 440.20 | N/A | N/A | Atherosclerosis of native arteries of the extremities, unspecified |
| 440.21 | N/A | N/A | Atherosclerosis of native arteries of the extremities with intermittent claudication |
| 440.22 | N/A | N/A | Atherosclerosis of native arteries of the extremities with rest pain |
| 440.23 | N/A | N/A | Atherosclerosis of native arteries of the extremities with ulceration |
| 440.24 | N/A | N/A | Atherosclerosis of native arteries of the extremities with gangrene |
| 440.29 | N/A | N/A | Other atherosclerosis of native arteries of the extremities |
| 440.4 | N/A | N/A | Chronic total occlusion of artery of the extremities |
| 444.01 | N/A | N/A | Saddle embolus of abdominal aorta |
| 444.09 | N/A | N/A | Other arterial embolism and thrombosis of abdominal aorta |
| 444.1 | N/A | N/A | Embolism and thrombosis of thoracic aorta |
| 444.21 | N/A | N/A | Arterial embolism and thrombosis of upper extremity |
| 444.22 | N/A | N/A | Arterial embolism and thrombosis of lower extremity |
| 444.81 | N/A | N/A | Embolism and thrombosis of iliac artery |
| 444.89 | N/A | N/A | Embolism and thrombosis of other specified artery |
| 444.9 | N/A | N/A | Embolism and thrombosis of unspecified artery |
| 445.01 | N/A | N/A | Atheroembolism of upper extremity |
| 445.02 | N/A | N/A | Atheroembolism of lower extremity |
| 445.81 | N/A | N/A | Atheroembolism of kidney |
| 445.89 | N/A | N/A | Atheroembolism 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.
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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