PQRS Measure
Report via: Registry, Measure Group
This measure is can be reported as part of the following groups:
• Inflammatory Bowel Disease (IBD) Group
• Inflammatory Bowel Disease (IBD) Group
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. | ||
| 99341 | Home or residence 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. | ||
| 99342 | Home or residence 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. | ||
| 99343 | Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. 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 of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. | ||
| 99344 | Home or residence 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, 60 minutes must be met or exceeded. | ||
| 99345 | Home or residence 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, 75 minutes must be met or exceeded. | ||
| 99346 | |||
| 99347 | Home or residence 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, 20 minutes must be met or exceeded. | ||
| 99348 | Home or residence 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, 30 minutes must be met or exceeded. | ||
| 99349 | Home or residence 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, 40 minutes must be met or exceeded. | ||
| 99350 | Home or residence 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, 60 minutes must be met or exceeded. | ||
| 99406 | Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes | ||
| 99407 | Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes | ||
| 3517F | Hepatitis B Virus (HBV) status assessed and results interpreted within one year prior to receiving a first course of anti-TNF (tumor necrosis factor) therapy (IBD) | ||
| 3517F | 8P | Hepatitis B Virus (HBV) status assessed and results interpreted within one year prior to receiving a first course of anti-TNF (tumor necrosis factor) therapy (IBD) | |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8869 | Patient has documented immunity to hepatitis b and initiating anti-tnf therapy | ||
| G9504 | Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| K50.00 | Crohn's disease of small intestine without complications | ||
| K50.011 | Crohn's disease of small intestine with rectal bleeding | ||
| K50.012 | Crohn's disease of small intestine with intestinal obstruction | ||
| K50.013 | Crohn's disease of small intestine with fistula | ||
| K50.014 | Crohn's disease of small intestine with abscess | ||
| K50.018 | Crohn's disease of small intestine with other complication | ||
| K50.019 | Crohn's disease of small intestine with unspecified complications | ||
| K50.10 | Crohn's disease of large intestine without complications | ||
| K50.111 | Crohn's disease of large intestine with rectal bleeding | ||
| K50.112 | Crohn's disease of large intestine with intestinal obstruction | ||
| K50.113 | Crohn's disease of large intestine with fistula | ||
| K50.114 | Crohn's disease of large intestine with abscess | ||
| K50.118 | Crohn's disease of large intestine with other complication | ||
| K50.119 | Crohn's disease of large intestine with unspecified complications | ||
| K50.80 | Crohn's disease of both small and large intestine without complications | ||
| K50.811 | Crohn's disease of both small and large intestine with rectal bleeding | ||
| K50.812 | Crohn's disease of both small and large intestine with intestinal obstruction | ||
| K50.813 | Crohn's disease of both small and large intestine with fistula | ||
| K50.814 | Crohn's disease of both small and large intestine with abscess | ||
| K50.818 | Crohn's disease of both small and large intestine with other complication | ||
| K50.819 | Crohn's disease of both small and large intestine with unspecified complications | ||
| K50.90 | Crohn's disease, unspecified, without complications | ||
| K50.911 | Crohn's disease, unspecified, with rectal bleeding | ||
| K50.912 | Crohn's disease, unspecified, with intestinal obstruction | ||
| K50.913 | Crohn's disease, unspecified, with fistula | ||
| K50.914 | Crohn's disease, unspecified, with abscess | ||
| K50.918 | Crohn's disease, unspecified, with other complication | ||
| K50.919 | Crohn's disease, unspecified, with unspecified complications | ||
| K51.00 | Ulcerative (chronic) pancolitis without complications | ||
| K51.011 | Ulcerative (chronic) pancolitis with rectal bleeding | ||
| K51.012 | Ulcerative (chronic) pancolitis with intestinal obstruction | ||
| K51.013 | Ulcerative (chronic) pancolitis with fistula | ||
| K51.014 | Ulcerative (chronic) pancolitis with abscess | ||
| K51.018 | Ulcerative (chronic) pancolitis with other complication | ||
| K51.019 | Ulcerative (chronic) pancolitis with unspecified complications | ||
| K51.20 | Ulcerative (chronic) proctitis without complications | ||
| K51.211 | Ulcerative (chronic) proctitis with rectal bleeding | ||
| K51.212 | Ulcerative (chronic) proctitis with intestinal obstruction | ||
| K51.213 | Ulcerative (chronic) proctitis with fistula | ||
| K51.214 | Ulcerative (chronic) proctitis with abscess | ||
| K51.218 | Ulcerative (chronic) proctitis with other complication | ||
| K51.219 | Ulcerative (chronic) proctitis with unspecified complications | ||
| K51.30 | Ulcerative (chronic) rectosigmoiditis without complications | ||
| K51.311 | Ulcerative (chronic) rectosigmoiditis with rectal bleeding | ||
| K51.312 | Ulcerative (chronic) rectosigmoiditis with intestinal obstruction | ||
| K51.313 | Ulcerative (chronic) rectosigmoiditis with fistula | ||
| K51.314 | Ulcerative (chronic) rectosigmoiditis with abscess | ||
| K51.318 | Ulcerative (chronic) rectosigmoiditis with other complication | ||
| K51.319 | Ulcerative (chronic) rectosigmoiditis with unspecified complications | ||
| K51.40 | Inflammatory polyps of colon without complications | ||
| K51.411 | Inflammatory polyps of colon with rectal bleeding | ||
| K51.412 | Inflammatory polyps of colon with intestinal obstruction | ||
| K51.413 | Inflammatory polyps of colon with fistula | ||
| K51.414 | Inflammatory polyps of colon with abscess | ||
| K51.418 | Inflammatory polyps of colon with other complication | ||
| K51.419 | Inflammatory polyps of colon with unspecified complications | ||
| K51.50 | Left sided colitis without complications | ||
| K51.511 | Left sided colitis with rectal bleeding | ||
| K51.512 | Left sided colitis with intestinal obstruction | ||
| K51.513 | Left sided colitis with fistula | ||
| K51.514 | Left sided colitis with abscess | ||
| K51.518 | Left sided colitis with other complication | ||
| K51.519 | Left sided colitis with unspecified complications | ||
| K51.80 | Other ulcerative colitis without complications | ||
| K51.811 | Other ulcerative colitis with rectal bleeding | ||
| K51.812 | Other ulcerative colitis with intestinal obstruction | ||
| K51.813 | Other ulcerative colitis with fistula | ||
| K51.814 | Other ulcerative colitis with abscess | ||
| K51.818 | Other ulcerative colitis with other complication | ||
| K51.819 | Other ulcerative colitis with unspecified complications | ||
| K51.90 | Ulcerative colitis, unspecified, without complications | ||
| K51.911 | Ulcerative colitis, unspecified with rectal bleeding | ||
| K51.912 | Ulcerative colitis, unspecified with intestinal obstruction | ||
| K51.913 | Ulcerative colitis, unspecified with fistula | ||
| K51.914 | Ulcerative colitis, unspecified with abscess | ||
| K51.918 | Ulcerative colitis, unspecified with other complication | ||
| K51.919 | Ulcerative colitis, unspecified with unspecified complications | ||
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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