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. | ||
| 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. | ||
| 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. | ||
| 99354 | Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; first hour (List separately in addition to code for outpatient Evaluation and Management or psychotherapy service, except with office or other outpatient services [99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215]) | ||
| 99355 | Prolonged service(s) in the outpatient setting requiring direct patient contact beyond the time of the usual service; each additional 30 minutes (List separately in addition to code for prolonged service) | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G9432 | Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented | ||
| G9433 | Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period | ||
| G9434 | Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given | ||
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 493.00 | Extrinsic asthma, unspecified | ||
| 493.01 | Extrinsic asthma with status asthmaticus | ||
| 493.02 | Extrinsic asthma with (acute) exacerbation | ||
| 493.10 | Intrinsic asthma, unspecified | ||
| 493.11 | Intrinsic asthma with status asthmaticus | ||
| 493.12 | Intrinsic asthma with (acute) exacerbation | ||
| 493.81 | Exercise induced bronchospasm | ||
| 493.82 | Cough variant asthma | ||
| 493.90 | Asthma, unspecified type, unspecified | ||
| 493.91 | Asthma, unspecified type, with status asthmaticus | ||
| 493.92 | Asthma, unspecified type, with (acute) exacerbation | ||
| 277.00 | Cystic fibrosis without mention of meconium ileus | ||
| 277.01 | Cystic fibrosis with meconium ileus | ||
| 277.02 | Cystic fibrosis with pulmonary manifestations | ||
| 277.03 | Cystic fibrosis with gastrointestinal manifestations | ||
| 277.09 | Cystic fibrosis with other manifestations | ||
| 491.20 | Obstructive chronic bronchitis without exacerbation | ||
| 491.21 | Obstructive chronic bronchitis with (acute) exacerbation | ||
| 491.22 | Obstructive chronic bronchitis with acute bronchitis | ||
| 492.0 | Emphysematous bleb | ||
| 492.8 | Other emphysema | ||
| 493.20 | Chronic obstructive asthma, unspecified | ||
| 493.21 | Chronic obstructive asthma with status asthmaticus | ||
| 493.22 | Chronic obstructive asthma with (acute) exacerbation | ||
| 496 | Chronic airway obstruction, not elsewhere classified | ||
| 506.4 | Chronic respiratory conditions due to fumes and vapors | ||
| 518.1 | Interstitial emphysema | ||
| 518.2 | Compensatory emphysema | ||
| 518.81 | Acute respiratory failure | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| J45.20 | Mild intermittent asthma, uncomplicated | ||
| J45.21 | Mild intermittent asthma with (acute) exacerbation | ||
| J45.22 | Mild intermittent asthma with status asthmaticus | ||
| J45.30 | Mild persistent asthma, uncomplicated | ||
| J45.31 | Mild persistent asthma with (acute) exacerbation | ||
| J45.32 | Mild persistent asthma with status asthmaticus | ||
| J45.40 | Moderate persistent asthma, uncomplicated | ||
| J45.41 | Moderate persistent asthma with (acute) exacerbation | ||
| J45.42 | Moderate persistent asthma with status asthmaticus | ||
| J45.50 | Severe persistent asthma, uncomplicated | ||
| J45.51 | Severe persistent asthma with (acute) exacerbation | ||
| J45.52 | Severe persistent asthma with status asthmaticus | ||
| J45.901 | Unspecified asthma with (acute) exacerbation | ||
| J45.902 | Unspecified asthma with status asthmaticus | ||
| J45.909 | Unspecified asthma, uncomplicated | ||
| J45.990 | Exercise induced bronchospasm | ||
| J45.991 | Cough variant asthma | ||
| J45.998 | Other asthma | ||
| E84.0 | Cystic fibrosis with pulmonary manifestations | ||
| E84.11 | Meconium ileus in cystic fibrosis | ||
| E84.19 | Cystic fibrosis with other intestinal manifestations | ||
| E84.8 | Cystic fibrosis with other manifestations | ||
| E84.9 | Cystic fibrosis, unspecified | ||
| J43.0 | Unilateral pulmonary emphysema [MacLeod's syndrome] | ||
| J43.1 | Panlobular emphysema | ||
| J43.2 | Centrilobular emphysema | ||
| J43.8 | Other emphysema | ||
| J43.9 | Emphysema, unspecified | ||
| J44.0 | Chronic obstructive pulmonary disease with (acute) lower respiratory infection | ||
| J44.1 | Chronic obstructive pulmonary disease with (acute) exacerbation | ||
| J44.9 | Chronic obstructive pulmonary disease, unspecified | ||
| J68.4 | Chronic respiratory conditions due to chemicals, gases, fumes and vapors | ||
| J96.00 | Acute respiratory failure, unspecified whether with hypoxia or hypercapnia | ||
| J96.01 | Acute respiratory failure with hypoxia | ||
| J96.02 | Acute respiratory failure with hypercapnia | ||
| J96.10 | Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia | ||
| J96.11 | Chronic respiratory failure with hypoxia | ||
| J96.12 | Chronic respiratory failure with hypercapnia | ||
| J96.20 | Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia | ||
| J96.21 | Acute and chronic respiratory failure with hypoxia | ||
| J96.22 | Acute and chronic respiratory failure with hypercapnia | ||
| J98.2 | Interstitial emphysema | ||
| J98.3 | Compensatory emphysema | ||
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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