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. | ||
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional | ||
| 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. | ||
| 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. | ||
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional | ||
| 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. | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G9432 | Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented | ||
| 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 | ||
| G9521 | Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months | ||
| G9522 | Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given | ||
| G9432 | Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented | ||
| 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 | ||
| G9521 | Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months | ||
| G9522 | Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given | ||
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 | ||
| J96.20 | 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 | ||
| 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 | ||
| J96.20 | 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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