PQRS Measure
#40Osteoporosis: Management Following Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older
Report via: Claim, Registry
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 22305 | N/A | N/A | Closed treatment of vertebral process fracture(s) |
| 22310 | N/A | N/A | Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing |
| 22315 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar |
| 22326 | N/A | N/A | Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical |
| 22327 | N/A | N/A | Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic |
| 22520 | N/A | N/A | Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic |
| 22521 | N/A | N/A | Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; lumbar |
| 22523 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation |
| 25607 | N/A | N/A | Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation |
| 25608 | N/A | N/A | Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments |
| 25609 | N/A | N/A | Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments |
| 27230 | N/A | N/A | Closed treatment of femoral fracture, proximal end, neck; without manipulation |
| 27232 | N/A | N/A | Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal traction |
| 27235 | N/A | N/A | Percutaneous skeletal fixation of femoral fracture, proximal end, neck |
| 27236 | N/A | N/A | Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement |
| 27238 | N/A | N/A | Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation |
| 27240 | N/A | N/A | Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with manipulation, with or without skin or skeletal traction |
| 27244 | N/A | N/A | Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage |
| 27245 | N/A | N/A | Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage |
| 27246 | N/A | N/A | Closed treatment of greater trochanteric fracture, without manipulation |
| 27248 | N/A | N/A | Open treatment of greater trochanteric fracture, includes internal fixation, when performed |
| 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. |
| 3095F | 1P | N/A | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) |
| 3095F | 2P | N/A | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) |
| 3095F | 3P | N/A | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) |
| 3095F | 8P | N/A | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) |
| 3095F | N/A | N/A | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) |
| 3096F | 1P | N/A | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) |
| 3096F | 2P | N/A | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) |
| 3096F | 3P | N/A | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) |
| 3096F | 8P | N/A | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) |
| 3096F | N/A | N/A | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) |
| 3095F | 8P | N/A | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) |
| 3095F | N/A | N/A | Central dual-energy X-ray absorptiometry (DXA) results documented (OP) (IBD) |
| 3096F | 8P | N/A | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) |
| 3096F | N/A | N/A | Central dual-energy X-ray absorptiometry (DXA) ordered (OP) (IBD) |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8633 | N/A | N/A | Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed |
| G8634 | N/A | N/A | Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis |
| G8635 | N/A | N/A | Pharmacologic therapy for osteoporosis was not prescribed, reason not given |
| G8633 | N/A | N/A | Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed |
| G8635 | N/A | N/A | Pharmacologic therapy for osteoporosis was not prescribed, reason not given |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 733.00 | N/A | N/A | Osteoporosis, unspecified |
| 733.01 | N/A | N/A | Senile osteoporosis |
| 733.02 | N/A | N/A | Idiopathic osteoporosis |
| 733.03 | N/A | N/A | Disuse osteoporosis |
| 733.09 | N/A | N/A | Other osteoporosis |
| 805.00 | N/A | N/A | Closed fracture of cervical vertebra, unspecified level |
| 805.01 | N/A | N/A | Closed fracture of first cervical vertebra |
| 805.02 | N/A | N/A | Closed fracture of second cervical vertebra |
| 805.03 | N/A | N/A | Closed fracture of third cervical vertebra |
| 805.04 | N/A | N/A | Closed fracture of fourth cervical vertebra |
| 805.05 | N/A | N/A | Closed fracture of fifth cervical vertebra |
| 805.06 | N/A | N/A | Closed fracture of sixth cervical vertebra |
| 805.07 | N/A | N/A | Closed fracture of seventh cervical vertebra |
| 805.08 | N/A | N/A | Closed fracture of multiple cervical vertebrae |
| 805.2 | N/A | N/A | Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury |
| 805.4 | N/A | N/A | Closed fracture of lumbar vertebra without mention of spinal cord injury |
| 805.6 | N/A | N/A | Closed fracture of sacrum and coccyx without mention of spinal cord injury |
| 805.8 | N/A | N/A | Closed fracture of unspecified vertebral column without mention of spinal cord injury |
| 813.40 | N/A | N/A | Closed fracture of lower end of forearm, unspecified |
| 813.41 | N/A | N/A | Closed Colles' fracture |
| 813.42 | N/A | N/A | Other closed fractures of distal end of radius (alone) |
| 813.44 | N/A | N/A | Closed fracture of lower end of radius with ulna |
| 813.45 | N/A | N/A | Torus fracture of radius (alone) |
| 813.47 | N/A | N/A | Torus fracture of radius and ulna |
| 813.50 | N/A | N/A | Open fracture of lower end of forearm, unspecified |
| 813.51 | N/A | N/A | Open Colles' fracture |
| 813.52 | N/A | N/A | Other open fractures of distal end of radius (alone) |
| 813.54 | N/A | N/A | Open fracture of lower end of radius with ulna |
| 820.00 | N/A | N/A | Closed fracture of intracapsular section of neck of femur, unspecified |
| 820.01 | N/A | N/A | Closed fracture of epiphysis (separation) (upper) of neck of femur |
| 820.02 | N/A | N/A | Closed fracture of midcervical section of neck of femur |
| 820.03 | N/A | N/A | Closed fracture of base of neck of femur |
| 820.09 | N/A | N/A | Other closed transcervical fracture of neck of femur |
| 820.20 | N/A | N/A | Closed fracture of trochanteric section of neck of femur |
| 820.21 | N/A | N/A | Closed fracture of intertrochanteric section of neck of femur |
| 820.22 | N/A | N/A | Closed fracture of subtrochanteric section of neck of femur |
| 820.8 | N/A | N/A | Closed fracture of unspecified part of neck of femur |
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 IThis measure can be submitted via Group Practice Reporting Option 1.
GPRO IIThis measure can be submitted via Group Practice Reporting Option 2.
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 IThis measure can be submitted via Group Practice Reporting Option 1.
GPRO IIThis measure can be submitted via Group Practice Reporting Option 2.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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