PQRS Measure
Report via: Claim, Registry, Measure Group
This measure is can be reported as part of the following groups:
• Chronic Obstructive Pulmonary Disease (COPD) Group
• Chronic Obstructive Pulmonary Disease (COPD) 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. | ||
| 4025F | 1P | Inhaled bronchodilator prescribed (COPD) | |
| 4025F | 2P | Inhaled bronchodilator prescribed (COPD) | |
| 4025F | 3P | Inhaled bronchodilator prescribed (COPD) | |
| 4025F | Inhaled bronchodilator prescribed (COPD) | ||
| 4025F | Inhaled bronchodilator prescribed (COPD) | ||
| 4025F | 8P | Inhaled bronchodilator prescribed (COPD) | |
| 4025F | 8P | Inhaled bronchodilator prescribed (COPD) | |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8924 | Spirometry results documented (fev1/fvc < 70%) | ||
| G8924 | Spirometry results documented (fev1/fvc < 70%) | ||
| G8924 | Spirometry results documented (fev1/fvc < 70%) | ||
| G8924 | Spirometry results documented (fev1/fvc < 70%) | ||
| G8925 | Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms | ||
| G8926 | Spirometry test not performed or documented, reason not given | ||
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 491.0 | Simple chronic bronchitis | ||
| 491.1 | Mucopurulent chronic bronchitis | ||
| 491.20 | Obstructive chronic bronchitis without exacerbation | ||
| 491.21 | Obstructive chronic bronchitis with (acute) exacerbation | ||
| 491.22 | Obstructive chronic bronchitis with acute bronchitis | ||
| 491.8 | Other chronic bronchitis | ||
| 491.9 | Unspecified chronic 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 | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| J41.0 | Simple chronic bronchitis | ||
| J41.1 | Mucopurulent chronic bronchitis | ||
| J41.8 | Mixed simple and mucopurulent chronic bronchitis | ||
| J42 | Unspecified chronic bronchitis | ||
| 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 | ||
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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