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PQRS Measure

#266Epilepsy: Seizure Type(s) and Current Seizure Frequency(ies)
 Report via: Claim, Registry

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
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.
99212N/AN/AOffice 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.
99213N/AN/AOffice 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.
99214N/AN/AOffice 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.
99215N/AN/AOffice 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.
99304N/AN/AInitial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
99305N/AN/AInitial nursing facility care, per day, for the evaluation and management of a 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, 35 minutes must be met or exceeded.
99306N/AN/AInitial nursing facility care, per day, for the evaluation and management of a 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, 50 minutes must be met or exceeded.
99307N/AN/ASubsequent nursing facility care, per day, for the evaluation and management of a 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.
99308N/AN/ASubsequent nursing facility care, per day, for the evaluation and management of a 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.
99309N/AN/ASubsequent nursing facility care, per day, for the evaluation and management of a 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.
1200FN/AN/ASeizure type(s) and current seizure frequency(ies) documented (EPI)
1200F1PN/ASeizure type(s) and current seizure frequency(ies) documented (EPI)
1200F2PN/ASeizure type(s) and current seizure frequency(ies) documented (EPI)
1200F8PN/ASeizure type(s) and current seizure frequency(ies) documented (EPI)

ICD9 Codes

CodeModifierPOSDescription
345.00N/AN/AGeneralized nonconvulsive epilepsy, without mention of intractable epilepsy
345.01N/AN/AGeneralized nonconvulsive epilepsy, with intractable epilepsy
345.10N/AN/AGeneralized convulsive epilepsy, without mention of intractable epilepsy
345.11N/AN/AGeneralized convulsive epilepsy, with intractable epilepsy
345.40N/AN/ALocalization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy
345.41N/AN/ALocalization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy
345.50N/AN/ALocalization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy
345.51N/AN/ALocalization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy
345.60N/AN/AInfantile spasms, without mention of intractable epilepsy
345.61N/AN/AInfantile spasms, with intractable epilepsy
345.70N/AN/AEpilepsia partialis continua, without mention of intractable epilepsy
345.71N/AN/AEpilepsia partialis continua, with intractable epilepsy
345.90N/AN/AEpilepsy, unspecified, without mention of intractable epilepsy
345.91N/AN/AEpilepsy, unspecified, with intractable epilepsy

ICD10CM Codes

CodeModifierPOSDescription
G40.001N/AN/ALocalization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus
G40.009N/AN/ALocalization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus
G40.011N/AN/ALocalization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus
G40.019N/AN/ALocalization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus
G40.101N/AN/ALocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus
G40.109N/AN/ALocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus
G40.111N/AN/ALocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus
G40.119N/AN/ALocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus
G40.201N/AN/ALocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus
G40.209N/AN/ALocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus
G40.211N/AN/ALocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus
G40.219N/AN/ALocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus
G40.309N/AN/AGeneralized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.311N/AN/AGeneralized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus
G40.319N/AN/AGeneralized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus
G40.401N/AN/AOther generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus
G40.409N/AN/AOther generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.411N/AN/AOther generalized epilepsy and epileptic syndromes, intractable, with status epilepticus
G40.419N/AN/AOther generalized epilepsy and epileptic syndromes, intractable, without status epilepticus
G40.901N/AN/AEpilepsy, unspecified, not intractable, with status epilepticus
G40.909N/AN/AEpilepsy, unspecified, not intractable, without status epilepticus
G40.911N/AN/AEpilepsy, unspecified, intractable, with status epilepticus
G40.919N/AN/AEpilepsy, unspecified, intractable, without status epilepticus
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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