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. | ||
| 33510 | Coronary artery bypass, vein only; single coronary venous graft | ||
| 33511 | Coronary artery bypass, vein only; 2 coronary venous grafts | ||
| 33512 | Coronary artery bypass, vein only; 3 coronary venous grafts | ||
| 33513 | Coronary artery bypass, vein only; 4 coronary venous grafts | ||
| 33514 | Coronary artery bypass, vein only; 5 coronary venous grafts | ||
| 33516 | Coronary artery bypass, vein only; 6 or more coronary venous grafts | ||
| 33517 | Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure) | ||
| 33518 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure) | ||
| 33519 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (List separately in addition to code for primary procedure) | ||
| 33521 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (List separately in addition to code for primary procedure) | ||
| 33522 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (List separately in addition to code for primary procedure) | ||
| 33523 | 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 | 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 | Coronary artery bypass, using arterial graft(s); single arterial graft | ||
| 33534 | Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts | ||
| 33535 | Coronary artery bypass, using arterial graft(s); 3 coronary arterial grafts | ||
| 33536 | Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts | ||
| 33572 | 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) | ||
| 33999 | Unlisted procedure, cardiac surgery | ||
| 35500 | 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 | Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open | ||
| 92920 | Percutaneous transluminal coronary angioplasty; single major coronary artery or branch | ||
| 92924 | Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch | ||
| 92928 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | ||
| 92933 | Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch | ||
| 92937 | 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 | 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 | 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 | ||
| 33361 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach | ||
| 33362 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach | ||
| 33363 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach | ||
| 33364 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach | ||
| 33365 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) | ||
| 33400 | Valvuloplasty, aortic valve; open, with cardiopulmonary bypass | ||
| 33401 | Valvuloplasty, aortic valve; open, with inflow occlusion | ||
| 33403 | Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass | ||
| 33404 | Construction of apical-aortic conduit | ||
| 33405 | Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve | ||
| 33406 | Replacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand) | ||
| 33410 | Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve | ||
| 33411 | Replacement, aortic valve; with aortic annulus enlargement, noncoronary sinus | ||
| 33412 | Replacement, aortic valve; with transventricular aortic annulus enlargement (Konno procedure) | ||
| 33413 | Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure) | ||
| 33414 | Repair of left ventricular outflow tract obstruction by patch enlargement of the outflow tract | ||
| 33415 | Resection or incision of subvalvular tissue for discrete subvalvular aortic stenosis | ||
| 33416 | Ventriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic stenosis (eg, asymmetric septal hypertrophy) | ||
| 33417 | Aortoplasty (gusset) for supravalvular stenosis | ||
| 33420 | Valvotomy, mitral valve; closed heart | ||
| 33422 | Valvotomy, mitral valve; open heart, with cardiopulmonary bypass | ||
| 33425 | Valvuloplasty, mitral valve, with cardiopulmonary bypass; | ||
| 33426 | Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring | ||
| 33427 | Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring | ||
| 33430 | Replacement, mitral valve, with cardiopulmonary bypass | ||
| 33463 | Valvuloplasty, tricuspid valve; without ring insertion | ||
| 33464 | Valvuloplasty, tricuspid valve; with ring insertion | ||
| 33465 | Replacement, tricuspid valve, with cardiopulmonary bypass | ||
| 33468 | Tricuspid valve repositioning and plication for Ebstein anomaly | ||
| 33470 | Valvotomy, pulmonary valve, closed heart; transventricular | ||
| 33471 | Valvotomy, pulmonary valve, closed heart, via pulmonary artery | ||
| 33472 | Valvotomy, pulmonary valve, open heart; with inflow occlusion | ||
| 33474 | Valvotomy, pulmonary valve, open heart, with cardiopulmonary bypass | ||
| 33475 | Replacement, pulmonary valve | ||
| 33476 | Right ventricular resection for infundibular stenosis, with or without commissurotomy | ||
| 33478 | Outflow tract augmentation (gusset), with or without commissurotomy or infundibular resection | ||
| 33496 | Repair of non-structural prosthetic valve dysfunction with cardiopulmonary bypass (separate procedure) | ||
| 33600 | Closure of atrioventricular valve (mitral or tricuspid) by suture or patch | ||
| 33602 | Closure of semilunar valve (aortic or pulmonary) by suture or patch | ||
| 33935 | Heart-lung transplant with recipient cardiectomy-pneumonectomy | ||
| 33945 | Heart transplant, with or without recipient cardiectomy | ||
| 1460F | Qualifying cardiac event/diagnosis in previous 12 months (CAD) | ||
| 4500F | Referred to an outpatient cardiac rehabilitation program (CAD) | ||
| 4500F | 1P | Referred to an outpatient cardiac rehabilitation program (CAD) | |
| 4500F | 2P | Referred to an outpatient cardiac rehabilitation program (CAD) | |
| 4500F | 3P | Referred to an outpatient cardiac rehabilitation program (CAD) | |
| 4500F | 8P | Referred to an outpatient cardiac rehabilitation program (CAD) | |
| 4510F | Previous cardiac rehabilitation for qualifying cardiac event completed (CAD) | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| 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 | ||
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 413.0 | Angina decubitus | ||
| 413.1 | Prinzmetal angina | ||
| 413.9 | Other and unspecified angina pectoris | ||
| 410.00 | Acute myocardial infarction of anterolateral wall, episode of care unspecified | ||
| 410.01 | Acute myocardial infarction of anterolateral wall, initial episode of care | ||
| 410.02 | Acute myocardial infarction of anterolateral wall, subsequent episode of care | ||
| 410.10 | Acute myocardial infarction of other anterior wall, episode of care unspecified | ||
| 410.11 | Acute myocardial infarction of other anterior wall, initial episode of care | ||
| 410.12 | Acute myocardial infarction of other anterior wall, subsequent episode of care | ||
| 410.20 | Acute myocardial infarction of inferolateral wall, episode of care unspecified | ||
| 410.21 | Acute myocardial infarction of inferolateral wall, initial episode of care | ||
| 410.22 | Acute myocardial infarction of inferolateral wall, subsequent episode of care | ||
| 410.30 | Acute myocardial infarction of inferoposterior wall, episode of care unspecified | ||
| 410.31 | Acute myocardial infarction of inferoposterior wall, initial episode of care | ||
| 410.32 | Acute myocardial infarction of inferoposterior wall, subsequent episode of care | ||
| 410.40 | Acute myocardial infarction of other inferior wall, episode of care unspecified | ||
| 410.41 | Acute myocardial infarction of other inferior wall, initial episode of care | ||
| 410.42 | Acute myocardial infarction of other inferior wall, subsequent episode of care | ||
| 410.50 | Acute myocardial infarction of other lateral wall, episode of care unspecified | ||
| 410.51 | Acute myocardial infarction of other lateral wall, initial episode of care | ||
| 410.52 | Acute myocardial infarction of other lateral wall, subsequent episode of care | ||
| 410.60 | True posterior wall infarction, episode of care unspecified | ||
| 410.61 | True posterior wall infarction, initial episode of care | ||
| 410.62 | True posterior wall infarction, subsequent episode of care | ||
| 410.70 | Subendocardial infarction, episode of care unspecified | ||
| 410.71 | Subendocardial infarction, initial episode of care | ||
| 410.72 | Subendocardial infarction, subsequent episode of care | ||
| 410.80 | Acute myocardial infarction of other specified sites, episode of care unspecified | ||
| 410.81 | Acute myocardial infarction of other specified sites, initial episode of care | ||
| 410.82 | Acute myocardial infarction of other specified sites, subsequent episode of care | ||
| 410.90 | Acute myocardial infarction of unspecified site, episode of care unspecified | ||
| 410.91 | Acute myocardial infarction of unspecified site, initial episode of care | ||
| 410.92 | Acute myocardial infarction of unspecified site, subsequent episode of care | ||
| 412 | Old myocardial infarction | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| I20.1 | Angina pectoris with documented spasm | ||
| I20.8 | Other forms of angina pectoris | ||
| I20.9 | Angina pectoris, unspecified | ||
| I21.01 | ST elevation (STEMI) myocardial infarction involving left main coronary artery | ||
| I21.02 | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery | ||
| I21.09 | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall | ||
| I21.11 | ST elevation (STEMI) myocardial infarction involving right coronary artery | ||
| I21.19 | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall | ||
| I21.21 | ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery | ||
| I21.29 | ST elevation (STEMI) myocardial infarction involving other sites | ||
| I21.3 | ST elevation (STEMI) myocardial infarction of unspecified site | ||
| I21.4 | Non-ST elevation (NSTEMI) myocardial infarction | ||
| I22.0 | Subsequent ST elevation (STEMI) myocardial infarction of anterior wall | ||
| I22.1 | Subsequent ST elevation (STEMI) myocardial infarction of inferior wall | ||
| I22.2 | Subsequent non-ST elevation (NSTEMI) myocardial infarction | ||
| I22.8 | Subsequent ST elevation (STEMI) myocardial infarction of other sites | ||
| I22.9 | Subsequent ST elevation (STEMI) myocardial infarction of unspecified site | ||
| I25.2 | 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).
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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