PQRS Measure
#40Osteoporosis: Management Following Fracture
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 22305 | Closed treatment of vertebral process fracture(s) | ||
| 22310 | Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing | ||
| 22315 | Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction | ||
| 22318 | Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting | ||
| 22319 | Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting | ||
| 22325 | Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar | ||
| 22326 | Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical | ||
| 22327 | Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic | ||
| 22520 | Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic | ||
| 22521 | Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; lumbar | ||
| 22523 | Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic | ||
| 22524 | Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); lumbar | ||
| 25600 | Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation | ||
| 25605 | Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation | ||
| 25606 | Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation | ||
| 25607 | Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation | ||
| 25608 | Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments | ||
| 25609 | Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments | ||
| 27230 | Closed treatment of femoral fracture, proximal end, neck; without manipulation | ||
| 27232 | Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal traction | ||
| 27235 | Percutaneous skeletal fixation of femoral fracture, proximal end, neck | ||
| 27236 | Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement | ||
| 27238 | Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation | ||
| 27240 | Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with manipulation, with or without skin or skeletal traction | ||
| 27244 | Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage | ||
| 27245 | Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage | ||
| 27246 | Closed treatment of greater trochanteric fracture, without manipulation | ||
| 27248 | Open treatment of greater trochanteric fracture, includes internal fixation, when performed | ||
| 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. | ||
| 99241 | Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and 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, 15 minutes are spent face-to-face with the patient and/or family. | ||
| 99242 | Office or other outpatient consultation for a new or 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. | ||
| 99243 | Office or other outpatient consultation for a new or 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. | ||
| 99244 | Office or other outpatient consultation for a new or 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. | ||
| 99245 | Office or other outpatient consultation for a new or 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, 55 minutes must be met or exceeded. | ||
| 3095F | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) | ||
| 3095F | 8P | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) | |
| 3095F | 1P | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) | |
| 3095F | 2P | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) | |
| 3095F | 3P | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) | |
| 3096F | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) | ||
| 3096F | 8P | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) | |
| 3096F | 1P | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) | |
| 3096F | 2P | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) | |
| 3096F | 3P | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) | |
| 4005F | Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (OP) (IBD) | ||
| 4005F | 8P | Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (OP) (IBD) | |
| 4005F | 1P | Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (OP) (IBD) | |
| 4005F | 2P | Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (OP) (IBD) | |
| 4005F | 3P | Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (OP) (IBD) | |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 733.12 | Pathologic fracture of distal radius and ulna | ||
| 733.13 | Pathologic fracture of vertebrae | ||
| 733.14 | Pathologic fracture of neck of femur | ||
| 805 | |||
| 805.01 | Closed fracture of first cervical vertebra | ||
| 805.02 | Closed fracture of second cervical vertebra | ||
| 805.03 | Closed fracture of third cervical vertebra | ||
| 805.04 | Closed fracture of fourth cervical vertebra | ||
| 805.05 | Closed fracture of fifth cervical vertebra | ||
| 805.06 | Closed fracture of sixth cervical vertebra | ||
| 805.07 | Closed fracture of seventh cervical vertebra | ||
| 805.08 | Closed fracture of multiple cervical vertebrae | ||
| 805.2 | Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury | ||
| 805.4 | Closed fracture of lumbar vertebra without mention of spinal cord injury | ||
| 805.6 | Closed fracture of sacrum and coccyx without mention of spinal cord injury | ||
| 805.8 | Closed fracture of unspecified vertebral column without mention of spinal cord injury | ||
| 813.4 | |||
| 813.41 | Closed Colles' fracture | ||
| 813.42 | Other closed fractures of distal end of radius (alone) | ||
| 813.44 | Closed fracture of lower end of radius with ulna | ||
| 813.45 | Torus fracture of radius (alone) | ||
| 813.5 | |||
| 813.51 | Open Colles' fracture | ||
| 813.52 | Other open fractures of distal end of radius (alone) | ||
| 813.54 | Open fracture of lower end of radius with ulna | ||
| 820 | |||
| 820.01 | Closed fracture of epiphysis (separation) (upper) of neck of femur | ||
| 820.02 | Closed fracture of midcervical section of neck of femur | ||
| 820.03 | Closed fracture of base of neck of femur | ||
| 820.09 | Other closed transcervical fracture of neck of femur | ||
| 820.2 | |||
| 820.21 | Closed fracture of intertrochanteric section of neck of femur | ||
| 820.22 | Closed fracture of subtrochanteric section of neck of femur | ||
| 820.8 | Closed fracture of unspecified part of neck of femur | ||
Legend:
Registry OKThis measure can be submitted through registry.
EHR OKThis measure can be submitted via Electronic Health Record (EHR).
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
Registry OKThis measure can be submitted through registry.
EHR OKThis measure can be submitted via Electronic Health Record (EHR).
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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