PQRS Measure
Report via: Claim, Registry
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 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. |
| 99304 | N/A | N/A | Initial 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. |
| 99305 | N/A | N/A | Initial 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. |
| 99306 | N/A | N/A | Initial 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. |
| 99307 | N/A | N/A | Subsequent 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. |
| 99308 | N/A | N/A | Subsequent 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. |
| 99309 | N/A | N/A | Subsequent 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. |
| 1205F | N/A | N/A | Etiology of epilepsy or epilepsy syndrome(s) reviewed and documented (EPI) |
| 1205F | 8P | N/A | Etiology of epilepsy or epilepsy syndrome(s) reviewed and documented (EPI) |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 345.00 | N/A | N/A | Generalized nonconvulsive epilepsy, without mention of intractable epilepsy |
| 345.01 | N/A | N/A | Generalized nonconvulsive epilepsy, with intractable epilepsy |
| 345.10 | N/A | N/A | Generalized convulsive epilepsy, without mention of intractable epilepsy |
| 345.11 | N/A | N/A | Generalized convulsive epilepsy, with intractable epilepsy |
| 345.40 | N/A | N/A | Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy |
| 345.41 | N/A | N/A | Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy |
| 345.50 | N/A | N/A | Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy |
| 345.51 | N/A | N/A | Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy |
| 345.60 | N/A | N/A | Infantile spasms, without mention of intractable epilepsy |
| 345.61 | N/A | N/A | Infantile spasms, with intractable epilepsy |
| 345.70 | N/A | N/A | Epilepsia partialis continua, without mention of intractable epilepsy |
| 345.71 | N/A | N/A | Epilepsia partialis continua, with intractable epilepsy |
| 345.90 | N/A | N/A | Epilepsy, unspecified, without mention of intractable epilepsy |
| 345.91 | N/A | N/A | Epilepsy, unspecified, with intractable epilepsy |
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| G40.001 | N/A | N/A | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus |
| G40.009 | N/A | N/A | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus |
| G40.011 | N/A | N/A | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus |
| G40.019 | N/A | N/A | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus |
| G40.101 | N/A | N/A | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus |
| G40.109 | N/A | N/A | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus |
| G40.111 | N/A | N/A | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus |
| G40.119 | N/A | N/A | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus |
| G40.201 | N/A | N/A | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus |
| G40.209 | N/A | N/A | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus |
| G40.211 | N/A | N/A | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus |
| G40.219 | N/A | N/A | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus |
| G40.309 | N/A | N/A | Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus |
| G40.309 | N/A | N/A | Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus |
| G40.311 | N/A | N/A | Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus |
| G40.311 | N/A | N/A | Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus |
| G40.319 | N/A | N/A | Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus |
| G40.401 | N/A | N/A | Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus |
| G40.409 | N/A | N/A | Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus |
| G40.411 | N/A | N/A | Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus |
| G40.419 | N/A | N/A | Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus |
| G40.901 | N/A | N/A | Epilepsy, unspecified, not intractable, with status epilepticus |
| G40.909 | N/A | N/A | Epilepsy, unspecified, not intractable, without status epilepticus |
| G40.911 | N/A | N/A | Epilepsy, unspecified, intractable, with status epilepticus |
| G40.919 | N/A | N/A | Epilepsy, 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.
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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