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PQRS Measure

#265Biopsy Follow-Up
 This measure may be submitted via Registry only

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
11100N/AN/ABiopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; single lesion
11755N/AN/ABiopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)
19081N/AN/ABiopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance
19083N/AN/ABiopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance
19085N/AN/ABiopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance
19100N/AN/ABiopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)
19101N/AN/ABiopsy of breast; open, incisional
19125N/AN/AExcision of breast lesion identified by preoperative placement of radiological marker, open; single lesion
20200N/AN/ABiopsy, muscle; superficial
20205N/AN/ABiopsy, muscle; deep
20206N/AN/ABiopsy, muscle, percutaneous needle
20220N/AN/ABiopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)
20225N/AN/ABiopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)
20240N/AN/ABiopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx)
20245N/AN/ABiopsy, bone, open; deep (eg, humeral shaft, ischium, femoral shaft)
20250N/AN/ABiopsy, vertebral body, open; thoracic
20251N/AN/ABiopsy, vertebral body, open; lumbar or cervical
21550N/AN/ABiopsy, soft tissue of neck or thorax
21920N/AN/ABiopsy, soft tissue of back or flank; superficial
21925N/AN/ABiopsy, soft tissue of back or flank; deep
23065N/AN/ABiopsy, soft tissue of shoulder area; superficial
23066N/AN/ABiopsy, soft tissue of shoulder area; deep
23100N/AN/AArthrotomy, glenohumeral joint, including biopsy
23101N/AN/AArthrotomy, acromioclavicular joint or sternoclavicular joint, including biopsy and/or excision of torn cartilage
24065N/AN/ABiopsy, soft tissue of upper arm or elbow area; superficial
24066N/AN/ABiopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular)
24100N/AN/AArthrotomy, elbow; with synovial biopsy only
24101N/AN/AArthrotomy, elbow; with joint exploration, with or without biopsy, with or without removal of loose or foreign body
25065N/AN/ABiopsy, soft tissue of forearm and/or wrist; superficial
25066N/AN/ABiopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular)
25100N/AN/AArthrotomy, wrist joint; with biopsy
25101N/AN/AArthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign body
26100N/AN/AArthrotomy with biopsy; carpometacarpal joint, each
26105N/AN/AArthrotomy with biopsy; metacarpophalangeal joint, each
26110N/AN/AArthrotomy with biopsy; interphalangeal joint, each
27040N/AN/ABiopsy, soft tissue of pelvis and hip area; superficial
27041N/AN/ABiopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscular
27050N/AN/AArthrotomy, with biopsy; sacroiliac joint
27052N/AN/AArthrotomy, with biopsy; hip joint
27323N/AN/ABiopsy, soft tissue of thigh or knee area; superficial
27324N/AN/ABiopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)
27330N/AN/AArthrotomy, knee; with synovial biopsy only
27331N/AN/AArthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies
27613N/AN/ABiopsy, soft tissue of leg or ankle area; superficial
27614N/AN/ABiopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)
27620N/AN/AArthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body
28050N/AN/AArthrotomy with biopsy; intertarsal or tarsometatarsal joint
28052N/AN/AArthrotomy with biopsy; metatarsophalangeal joint
28054N/AN/AArthrotomy with biopsy; interphalangeal joint
29800N/AN/AArthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)
29805N/AN/AArthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)
29830N/AN/AArthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure)
29840N/AN/AArthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure)
29860N/AN/AArthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)
29870N/AN/AArthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
29900N/AN/AArthroscopy, metacarpophalangeal joint, diagnostic, includes synovial biopsy
30100N/AN/ABiopsy, intranasal
31050N/AN/ASinusotomy, sphenoid, with or without biopsy;
31051N/AN/ASinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s)
31237N/AN/ANasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)
31510N/AN/ALaryngoscopy, indirect; with biopsy
31576N/AN/ALaryngoscopy, flexible; with biopsy(ies)
31625N/AN/ABronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites
31628N/AN/ABronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe
31629N/AN/ABronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)
31632N/AN/ABronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)
31633N/AN/ABronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure)
31717N/AN/ACatheterization with bronchial brush biopsy
32096N/AN/AThoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral
32097N/AN/AThoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral
32098N/AN/AThoracotomy, with biopsy(ies) of pleura
32400N/AN/ABiopsy, pleura, percutaneous needle
32405N/AN/ABiopsy, lung or mediastinum, percutaneous needle
32604N/AN/AThoracoscopy, diagnostic (separate procedure); pericardial sac, with biopsy
32606N/AN/AThoracoscopy, diagnostic (separate procedure); mediastinal space, with biopsy
32607N/AN/AThoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral
32608N/AN/AThoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral
32609N/AN/AThoracoscopy; with biopsy(ies) of pleura
37200N/AN/ATranscatheter biopsy
37609N/AN/ALigation or biopsy, temporal artery
38221N/AN/ADiagnostic bone marrow; biopsy(ies)
38500N/AN/ABiopsy or excision of lymph node(s); open, superficial
38505N/AN/ABiopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary)
38510N/AN/ABiopsy or excision of lymph node(s); open, deep cervical node(s)
38520N/AN/ABiopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad
38525N/AN/ABiopsy or excision of lymph node(s); open, deep axillary node(s)
38530N/AN/ABiopsy or excision of lymph node(s); open, internal mammary node(s)
38570N/AN/ALaparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple
38572N/AN/ALaparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple
39400N/AN/AMediastinoscopy, includes biopsy(ies), when performed
40490N/AN/ABiopsy of lip
40808N/AN/ABiopsy, vestibule of mouth
41100N/AN/ABiopsy of tongue; anterior two-thirds
41105N/AN/ABiopsy of tongue; posterior one-third
41108N/AN/ABiopsy of floor of mouth
42100N/AN/ABiopsy of palate, uvula
42400N/AN/ABiopsy of salivary gland; needle
42405N/AN/ABiopsy of salivary gland; incisional
42800N/AN/ABiopsy; oropharynx
42804N/AN/ABiopsy; nasopharynx, visible lesion, simple
42806N/AN/ABiopsy; nasopharynx, survey for unknown primary lesion
43193N/AN/AEsophagoscopy, rigid, transoral; with biopsy, single or multiple
43197N/AN/AEsophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
43198N/AN/AEsophagoscopy, flexible, transnasal; with biopsy, single or multiple
43202N/AN/AEsophagoscopy, flexible, transoral; with biopsy, single or multiple
43239N/AN/AEsophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
43261N/AN/AEndoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple
43605N/AN/ABiopsy of stomach, by laparotomy
44010N/AN/ADuodenotomy, for exploration, biopsy(s), or foreign body removal
44020N/AN/AEnterotomy, small intestine, other than duodenum; for exploration, biopsy(s), or foreign body removal
44025N/AN/AColotomy, for exploration, biopsy(s), or foreign body removal
44100N/AN/ABiopsy of intestine by capsule, tube, peroral (1 or more specimens)
44322N/AN/AColostomy or skin level cecostomy; with multiple biopsies (eg, for congenital megacolon) (separate procedure)
44361N/AN/ASmall intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple
44377N/AN/ASmall intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy, single or multiple
44382N/AN/AIleoscopy, through stoma; with biopsy, single or multiple
44386N/AN/AEndoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); with biopsy, single or multiple
44389N/AN/AColonoscopy through stoma; with biopsy, single or multiple
45100N/AN/ABiopsy of anorectal wall, anal approach (eg, congenital megacolon)
45305N/AN/AProctosigmoidoscopy, rigid; with biopsy, single or multiple
45331N/AN/ASigmoidoscopy, flexible; with biopsy, single or multiple
45380N/AN/AColonoscopy, flexible; with biopsy, single or multiple
45392N/AN/AColonoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures
46606N/AN/AAnoscopy; with biopsy, single or multiple
47000N/AN/ABiopsy of liver, needle; percutaneous
47001N/AN/ABiopsy of liver, needle; when done for indicated purpose at time of other major procedure (List separately in addition to code for primary procedure)
47100N/AN/ABiopsy of liver, wedge
47553N/AN/ABiliary endoscopy, percutaneous via T-tube or other tract; with biopsy, single or multiple
47561N/AN/ALaparoscopy, surgical; with guided transhepatic cholangiography with biopsy
48100N/AN/ABiopsy of pancreas, open (eg, fine needle aspiration, needle core biopsy, wedge biopsy)
48102N/AN/ABiopsy of pancreas, percutaneous needle
49000N/AN/AExploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)
49010N/AN/AExploration, retroperitoneal area with or without biopsy(s) (separate procedure)
49180N/AN/ABiopsy, abdominal or retroperitoneal mass, percutaneous needle
49321N/AN/ALaparoscopy, surgical; with biopsy (single or multiple)
50200N/AN/ARenal biopsy; percutaneous, by trocar or needle
50205N/AN/ARenal biopsy; by surgical exposure of kidney
50555N/AN/ARenal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy
50557N/AN/ARenal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy
50574N/AN/ARenal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy
50576N/AN/ARenal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy
50955N/AN/AUreteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy
50957N/AN/AUreteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy
50974N/AN/AUreteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy
50976N/AN/AUreteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy
52007N/AN/ACystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis
52204N/AN/ACystourethroscopy, with biopsy(s)
52224N/AN/ACystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy
52250N/AN/ACystourethroscopy with insertion of radioactive substance, with or without biopsy or fulguration
52354N/AN/ACystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion
53200N/AN/ABiopsy of urethra
54100N/AN/ABiopsy of penis; (separate procedure)
54105N/AN/ABiopsy of penis; deep structures
54500N/AN/ABiopsy of testis, needle (separate procedure)
54505N/AN/ABiopsy of testis, incisional (separate procedure)
54800N/AN/ABiopsy of epididymis, needle
54865N/AN/AExploration of epididymis, with or without biopsy
55700N/AN/ABiopsy, prostate; needle or punch, single or multiple, any approach
55705N/AN/ABiopsy, prostate; incisional, any approach
55706N/AN/ABiopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance
55812N/AN/AProstatectomy, perineal radical; with lymph node biopsy(s) (limited pelvic lymphadenectomy)
55842N/AN/AProstatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy(s) (limited pelvic lymphadenectomy)
55862N/AN/AExposure of prostate, any approach, for insertion of radioactive substance; with lymph node biopsy(s) (limited pelvic lymphadenectomy)
56605N/AN/ABiopsy of vulva or perineum (separate procedure); 1 lesion
56821N/AN/AColposcopy of the vulva; with biopsy(s)
57100N/AN/ABiopsy of vaginal mucosa; simple (separate procedure)
57105N/AN/ABiopsy of vaginal mucosa; extensive, requiring suture (including cysts)
57421N/AN/AColposcopy of the entire vagina, with cervix if present; with biopsy(s) of vagina/cervix
57454N/AN/AColposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage
57455N/AN/AColposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix
57460N/AN/AColposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix
57500N/AN/ABiopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure)
57520N/AN/AConization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser
58100N/AN/AEndometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)
58558N/AN/AHysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C
58900N/AN/ABiopsy of ovary, unilateral or bilateral (separate procedure)
59015N/AN/AChorionic villus sampling, any method
60100N/AN/ABiopsy thyroid, percutaneous core needle
60540N/AN/AAdrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure);
60545N/AN/AAdrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure); with excision of adjacent retroperitoneal tumor
60650N/AN/ALaparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal
61140N/AN/ABurr hole(s) or trephine; with biopsy of brain or intracranial lesion
61575N/AN/ATransoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion;
61576N/AN/ATransoral approach to skull base, brain stem or upper spinal cord for biopsy, decompression or excision of lesion; requiring splitting of tongue and/or mandible (including tracheostomy)
61750N/AN/AStereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion;
61751N/AN/AStereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion; with computed tomography and/or magnetic resonance guidance
62269N/AN/ABiopsy of spinal cord, percutaneous needle
63275N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; extradural, cervical
63276N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic
63277N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar
63278N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral
63280N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical
63281N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, thoracic
63282N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, lumbar
63283N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; intradural, sacral
63285N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical
63286N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracic
63287N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar
63290N/AN/ALaminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level
63615N/AN/AStereotactic biopsy, aspiration, or excision of lesion, spinal cord
64795N/AN/ABiopsy of nerve
65410N/AN/ABiopsy of cornea
67346N/AN/ABiopsy of extraocular muscle
67400N/AN/AOrbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy
67450N/AN/AOrbitotomy with bone flap or window, lateral approach (eg, Kroenlein); for exploration, with or without biopsy
67810N/AN/AIncisional biopsy of eyelid skin including lid margin
68100N/AN/ABiopsy of conjunctiva
68510N/AN/ABiopsy of lacrimal gland
68525N/AN/ABiopsy of lacrimal sac
69100N/AN/ABiopsy external ear
69105N/AN/ABiopsy external auditory canal
75970N/AN/ATranscatheter biopsy, radiological supervision and interpretation
89290N/AN/ABiopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); less than or equal to 5 embryos
89291N/AN/ABiopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); greater than 5 embryos
93505N/AN/AEndomyocardial biopsy
99201N/AN/AOffice 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.
99202N/AN/AOffice 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.
99203N/AN/AOffice 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.
99204N/AN/AOffice 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.
99205N/AN/AOffice 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.

HCPCS Codes

CodeModifierPOSDescription
G8883N/AN/ABiopsy results reviewed, communicated, tracked and documented
G8884N/AN/AClinician documented reason that patient's biopsy results were not reviewed
G8885N/AN/ABiopsy results not reviewed, communicated, tracked or documented
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.
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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