PQRS Information

Year: 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007

PQRS Measure

#243Cardiac Rehabilitation Patient Referral From an Outpatient Setting

This measure may be submitted via Registry only

The following codes apply for this PQRS measure:

Code	Modifier	POS	Description
CPT Codes
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.
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.
99387	N/A	N/A	Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
99395	N/A	N/A	Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
99396	N/A	N/A	Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
G0438	N/A	N/A
G0439	N/A	N/A
33361	N/A	N/A	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach
33362	N/A	N/A	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach
33363	N/A	N/A	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach
33364	N/A	N/A	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach
33365	N/A	N/A	Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy)
33400	N/A	N/A	Valvuloplasty, aortic valve; open, with cardiopulmonary bypass
33401	N/A	N/A	Valvuloplasty, aortic valve; open, with inflow occlusion
33403	N/A	N/A	Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass
33404	N/A	N/A	Construction of apical-aortic conduit
33405	N/A	N/A	Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve
33406	N/A	N/A	Replacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand)
33410	N/A	N/A	Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve
33411	N/A	N/A	Replacement, aortic valve; with aortic annulus enlargement, noncoronary sinus
33412	N/A	N/A	Replacement, aortic valve; with transventricular aortic annulus enlargement (Konno procedure)
33413	N/A	N/A	Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure)
33414	N/A	N/A	Repair of left ventricular outflow tract obstruction by patch enlargement of the outflow tract
33415	N/A	N/A	Resection or incision of subvalvular tissue for discrete subvalvular aortic stenosis
33416	N/A	N/A	Ventriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic stenosis (eg, asymmetric septal hypertrophy)
33417	N/A	N/A	Aortoplasty (gusset) for supravalvular stenosis
33420	N/A	N/A	Valvotomy, mitral valve; closed heart
33422	N/A	N/A	Valvotomy, mitral valve; open heart, with cardiopulmonary bypass
33425	N/A	N/A	Valvuloplasty, mitral valve, with cardiopulmonary bypass;
33426	N/A	N/A	Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring
33427	N/A	N/A	Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring
33430	N/A	N/A	Replacement, mitral valve, with cardiopulmonary bypass
33463	N/A	N/A	Valvuloplasty, tricuspid valve; without ring insertion
33464	N/A	N/A	Valvuloplasty, tricuspid valve; with ring insertion
33465	N/A	N/A	Replacement, tricuspid valve, with cardiopulmonary bypass
33468	N/A	N/A	Tricuspid valve repositioning and plication for Ebstein anomaly
33470	N/A	N/A	Valvotomy, pulmonary valve, closed heart; transventricular
33471	N/A	N/A	Valvotomy, pulmonary valve, closed heart, via pulmonary artery
33472	N/A	N/A	Valvotomy, pulmonary valve, open heart; with inflow occlusion
33474	N/A	N/A	Valvotomy, pulmonary valve, open heart, with cardiopulmonary bypass
33475	N/A	N/A	Replacement, pulmonary valve
33476	N/A	N/A	Right ventricular resection for infundibular stenosis, with or without commissurotomy
33478	N/A	N/A	Outflow tract augmentation (gusset), with or without commissurotomy or infundibular resection
33496	N/A	N/A	Repair of non-structural prosthetic valve dysfunction with cardiopulmonary bypass (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)
33530	N/A	N/A	Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (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
33572	N/A	N/A	Coronary endarterectomy, open, any method, of left anterior descending, circumflex, or right coronary artery performed in conjunction with coronary artery bypass graft procedure, each vessel (List separately in addition to primary procedure)
33600	N/A	N/A	Closure of atrioventricular valve (mitral or tricuspid) by suture or patch
33602	N/A	N/A	Closure of semilunar valve (aortic or pulmonary) by suture or patch
33935	N/A	N/A	Heart-lung transplant with recipient cardiectomy-pneumonectomy
33945	N/A	N/A	Heart transplant, with or without recipient cardiectomy
33999	N/A	N/A	Unlisted procedure, cardiac surgery
35500	N/A	N/A	Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure)
35600	N/A	N/A	Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open
92920	N/A	N/A	Percutaneous transluminal coronary angioplasty; single major coronary artery or branch
92924	N/A	N/A	Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch
92928	N/A	N/A	Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
92933	N/A	N/A	Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
92937	N/A	N/A	Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel
92941	N/A	N/A	Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
92943	N/A	N/A	Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel
G0290	N/A	N/A
G0291	N/A	N/A
1460F	N/A	N/A	Qualifying cardiac event/diagnosis in previous 12 months (CAD)
4500F	N/A	N/A	Referred to an outpatient cardiac rehabilitation program (CAD)
4500F	1P	N/A	Referred to an outpatient cardiac rehabilitation program (CAD)
4500F	2P	N/A	Referred to an outpatient cardiac rehabilitation program (CAD)
4500F	3P	N/A	Referred to an outpatient cardiac rehabilitation program (CAD)
4500F	8P	N/A	Referred to an outpatient cardiac rehabilitation program (CAD)
4510F	N/A	N/A	Previous cardiac rehabilitation for qualifying cardiac event completed (CAD)
ICD9 Codes
Code	Modifier	POS	Description
410.00	N/A	N/A	Acute myocardial infarction of anterolateral wall, episode of care unspecified
410.01	N/A	N/A	Acute myocardial infarction of anterolateral wall, initial episode of care
410.02	N/A	N/A	Acute myocardial infarction of anterolateral wall, subsequent episode of care
410.10	N/A	N/A	Acute myocardial infarction of other anterior wall, episode of care unspecified
410.11	N/A	N/A	Acute myocardial infarction of other anterior wall, initial episode of care
410.12	N/A	N/A	Acute myocardial infarction of other anterior wall, subsequent episode of care
410.20	N/A	N/A	Acute myocardial infarction of inferolateral wall, episode of care unspecified
410.21	N/A	N/A	Acute myocardial infarction of inferolateral wall, initial episode of care
410.22	N/A	N/A	Acute myocardial infarction of inferolateral wall, subsequent episode of care
410.30	N/A	N/A	Acute myocardial infarction of inferoposterior wall, episode of care unspecified
410.31	N/A	N/A	Acute myocardial infarction of inferoposterior wall, initial episode of care
410.32	N/A	N/A	Acute myocardial infarction of inferoposterior wall, subsequent episode of care
410.40	N/A	N/A	Acute myocardial infarction of other inferior wall, episode of care unspecified
410.41	N/A	N/A	Acute myocardial infarction of other inferior wall, initial episode of care
410.42	N/A	N/A	Acute myocardial infarction of other inferior wall, subsequent episode of care
410.50	N/A	N/A	Acute myocardial infarction of other lateral wall, episode of care unspecified
410.51	N/A	N/A	Acute myocardial infarction of other lateral wall, initial episode of care
410.52	N/A	N/A	Acute myocardial infarction of other lateral wall, subsequent episode of care
410.60	N/A	N/A	True posterior wall infarction, episode of care unspecified
410.61	N/A	N/A	True posterior wall infarction, initial episode of care
410.62	N/A	N/A	True posterior wall infarction, subsequent episode of care
410.70	N/A	N/A	Subendocardial infarction, episode of care unspecified
410.71	N/A	N/A	Subendocardial infarction, initial episode of care
410.72	N/A	N/A	Subendocardial infarction, subsequent episode of care
410.80	N/A	N/A	Acute myocardial infarction of other specified sites, episode of care unspecified
410.81	N/A	N/A	Acute myocardial infarction of other specified sites, initial episode of care
410.82	N/A	N/A	Acute myocardial infarction of other specified sites, subsequent episode of care
410.90	N/A	N/A	Acute myocardial infarction of unspecified site, episode of care unspecified
410.91	N/A	N/A	Acute myocardial infarction of unspecified site, initial episode of care
410.92	N/A	N/A	Acute myocardial infarction of unspecified site, subsequent episode of care
412	N/A	N/A	Old myocardial infarction
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
ICD10CM Codes
Code	Modifier	POS	Description
I20.1	N/A	N/A	Angina pectoris with documented spasm
I20.8	N/A	N/A	Other forms of angina pectoris
I20.9	N/A	N/A	Angina pectoris, unspecified
121.01	N/A	N/A
121.02	N/A	N/A
I21.09	N/A	N/A	ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11	N/A	N/A	ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19	N/A	N/A	ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21	N/A	N/A	ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29	N/A	N/A	ST elevation (STEMI) myocardial infarction involving other sites
I21.3	N/A	N/A	ST elevation (STEMI) myocardial infarction of unspecified site
I21.4	N/A	N/A	Non-ST elevation (NSTEMI) myocardial infarction
122.0	N/A	N/A
122.1	N/A	N/A
122.2	N/A	N/A
122.8	N/A	N/A
122.9	N/A	N/A
I25.2	N/A	N/A	Old myocardial infarction

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.

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