PQRS Measure
#59Empiric Antibiotic for Community-Acquired Bacterial Pneumonia
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 4045F | Appropriate empiric antibiotic prescribed (CAP), (EM) | ||
| 4045F | 8P | Appropriate empiric antibiotic prescribed (CAP), (EM) | |
| 4045F | 1P | Appropriate empiric antibiotic prescribed (CAP), (EM) | |
| 4045F | 2P | Appropriate empiric antibiotic prescribed (CAP), (EM) | |
| 4045F | 3P | Appropriate empiric antibiotic prescribed (CAP), (EM) | |
| 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. | ||
| 99281 | Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional | ||
| 99282 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making | ||
| 99283 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making | ||
| 99284 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making | ||
| 99285 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making | ||
| 99291 | 23 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 481 | Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia] | ||
| 482.0 | Pneumonia due to Klebsiella pneumoniae | ||
| 482.1 | Pneumonia due to Pseudomonas | ||
| 482.2 | Pneumonia due to Hemophilus influenzae [H. influenzae] | ||
| 482.30 | Pneumonia due to Streptococcus, unspecified | ||
| 482.31 | Pneumonia due to Streptococcus, group A | ||
| 482.32 | Pneumonia due to Streptococcus, group B | ||
| 482.39 | Pneumonia due to other Streptococcus | ||
| 482.40 | Pneumonia due to Staphylococcus, unspecified | ||
| 482.41 | Methicillin susceptible pneumonia due to Staphylococcus aureus | ||
| 482.49 | Other Staphylococcus pneumonia | ||
| 482.81 | Pneumonia due to anaerobes | ||
| 482.82 | Pneumonia due to escherichia coli [E. coli] | ||
| 482.83 | Pneumonia due to other gram-negative bacteria | ||
| 482.84 | Pneumonia due to Legionnaires' disease | ||
| 482.89 | Pneumonia due to other specified bacteria | ||
| 482.9 | Bacterial pneumonia, unspecified | ||
| 483.0 | Pneumonia due to mycoplasma pneumoniae | ||
| 483.1 | Pneumonia due to chlamydia | ||
| 483.8 | Pneumonia due to other specified organism | ||
| 485 | Bronchopneumonia, organism unspecified | ||
| 486 | Pneumonia, organism unspecified | ||
| 487.0 | Influenza with pneumonia | ||
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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