PQRS Measure
Report via: Claim, Registry, EHR, Measure Group
This measure is can be reported as part of the following groups:
• Coronary Artery Disease (CAD) Group
• Coronary Artery Disease (CAD) Group
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 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. |
| 99304 | N/A | N/A | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. |
| 99305 | N/A | N/A | Initial nursing facility care, per day, for the evaluation and management of a 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, 35 minutes must be met or exceeded. |
| 99306 | N/A | N/A | Initial nursing facility care, per day, for the evaluation and management of a 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, 50 minutes must be met or exceeded. |
| 99307 | N/A | N/A | Subsequent nursing facility care, per day, for the evaluation and management of a 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. |
| 99308 | N/A | N/A | Subsequent nursing facility care, per day, for the evaluation and management of a 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. |
| 99309 | N/A | N/A | Subsequent nursing facility care, per day, for the evaluation and management of a 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. |
| 99310 | N/A | N/A | Subsequent nursing facility care, per day, for the evaluation and management of a 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, 45 minutes must be met or exceeded. |
| 99324 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new 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 of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver. |
| 99325 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. 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 of moderate severity. Typically, 30 minutes are spent with the patient and/or family or caregiver. |
| 99326 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. 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 of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver. |
| 99327 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. 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 of high severity. Typically, 60 minutes are spent with the patient and/or family or caregiver. |
| 99328 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. 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 patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver. |
| 99334 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval 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, 15 minutes are spent with the patient and/or family or caregiver. |
| 99335 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. 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 of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver. |
| 99336 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. 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 of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver. |
| 99337 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. 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 of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver. |
| 99341 | N/A | N/A | Home or residence 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. |
| 99342 | N/A | N/A | Home or residence 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. |
| 99343 | N/A | N/A | Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. 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 of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| 99344 | N/A | N/A | Home or residence 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, 60 minutes must be met or exceeded. |
| 99345 | N/A | N/A | Home or residence 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, 75 minutes must be met or exceeded. |
| 99347 | N/A | N/A | Home or residence 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, 20 minutes must be met or exceeded. |
| 99348 | N/A | N/A | Home or residence 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, 30 minutes must be met or exceeded. |
| 99349 | N/A | N/A | Home or residence 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, 40 minutes must be met or exceeded. |
| 99350 | N/A | N/A | Home or residence 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, 60 minutes must be met or exceeded. |
| 4086F | N/A | N/A | Aspirin or clopidogrel prescribed or currently being taken (CAD) |
| 4086F | 8P | N/A | Aspirin or clopidogrel prescribed or currently being taken (CAD) |
| 4086F | 1P | N/A | Aspirin or clopidogrel prescribed or currently being taken (CAD) |
| 4086F | 2P | N/A | Aspirin or clopidogrel prescribed or currently being taken (CAD) |
| 4086F | 3P | N/A | Aspirin or clopidogrel prescribed or currently being taken (CAD) |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 410.00 | N/A | N/A | Acute myocardial infarction of anterolateral wall, episode of care unspecified |
| 410.01 | N/A | N/A | Acute myocardial infarction of anterolateral wall, initial episode of care |
| 410.02 | N/A | N/A | Acute myocardial infarction of anterolateral wall, subsequent episode of care |
| 410.10 | N/A | N/A | Acute myocardial infarction of other anterior wall, episode of care unspecified |
| 410.11 | N/A | N/A | Acute myocardial infarction of other anterior wall, initial episode of care |
| 410.12 | N/A | N/A | Acute myocardial infarction of other anterior wall, subsequent episode of care |
| 410.20 | N/A | N/A | Acute myocardial infarction of inferolateral wall, episode of care unspecified |
| 410.21 | N/A | N/A | Acute myocardial infarction of inferolateral wall, initial episode of care |
| 410.22 | N/A | N/A | Acute myocardial infarction of inferolateral wall, subsequent episode of care |
| 410.30 | N/A | N/A | Acute myocardial infarction of inferoposterior wall, episode of care unspecified |
| 410.31 | N/A | N/A | Acute myocardial infarction of inferoposterior wall, initial episode of care |
| 410.32 | N/A | N/A | Acute myocardial infarction of inferoposterior wall, subsequent episode of care |
| 410.40 | N/A | N/A | Acute myocardial infarction of other inferior wall, episode of care unspecified |
| 410.41 | N/A | N/A | Acute myocardial infarction of other inferior wall, initial episode of care |
| 410.42 | N/A | N/A | Acute myocardial infarction of other inferior wall, subsequent episode of care |
| 410.50 | N/A | N/A | Acute myocardial infarction of other lateral wall, episode of care unspecified |
| 410.51 | N/A | N/A | Acute myocardial infarction of other lateral wall, initial episode of care |
| 410.52 | N/A | N/A | Acute myocardial infarction of other lateral wall, subsequent episode of care |
| 410.60 | N/A | N/A | True posterior wall infarction, episode of care unspecified |
| 410.61 | N/A | N/A | True posterior wall infarction, initial episode of care |
| 410.62 | N/A | N/A | True posterior wall infarction, subsequent episode of care |
| 410.70 | N/A | N/A | Subendocardial infarction, episode of care unspecified |
| 410.71 | N/A | N/A | Subendocardial infarction, initial episode of care |
| 410.72 | N/A | N/A | Subendocardial infarction, subsequent episode of care |
| 410.80 | N/A | N/A | Acute myocardial infarction of other specified sites, episode of care unspecified |
| 410.81 | N/A | N/A | Acute myocardial infarction of other specified sites, initial episode of care |
| 410.82 | N/A | N/A | Acute myocardial infarction of other specified sites, subsequent episode of care |
| 410.90 | N/A | N/A | Acute myocardial infarction of unspecified site, episode of care unspecified |
| 410.91 | N/A | N/A | Acute myocardial infarction of unspecified site, initial episode of care |
| 410.92 | N/A | N/A | Acute myocardial infarction of unspecified site, subsequent episode of care |
| 411.0 | N/A | N/A | Postmyocardial infarction syndrome |
| 411.1 | N/A | N/A | Intermediate coronary syndrome |
| 411.81 | N/A | N/A | Acute coronary occlusion without myocardial infarction |
| 411.89 | N/A | N/A | Other acute and subacute forms of ischemic heart disease, other |
| 412 | N/A | N/A | Old myocardial infarction |
| 413.0 | N/A | N/A | Angina decubitus |
| 413.1 | N/A | N/A | Prinzmetal angina |
| 413.9 | N/A | N/A | Other and unspecified angina pectoris |
| 414.00 | N/A | N/A | Coronary atherosclerosis of unspecified type of vessel, native or graft |
| 414.01 | N/A | N/A | Coronary atherosclerosis of native coronary artery |
| 414.02 | N/A | N/A | Coronary atherosclerosis of autologous vein bypass graft |
| 414.03 | N/A | N/A | Coronary atherosclerosis of nonautologous biological bypass graft |
| 414.04 | N/A | N/A | Coronary atherosclerosis of artery bypass graft |
| 414.05 | N/A | N/A | Coronary atherosclerosis of unspecified bypass graft |
| 414.06 | N/A | N/A | Coronary atherosclerosis of native coronary artery of transplanted heart |
| 414.07 | N/A | N/A | Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart |
| 414.2 | N/A | N/A | Chronic total occlusion of coronary artery |
| 414.3 | N/A | N/A | Coronary atherosclerosis due to lipid rich plaque |
| 414.8 | N/A | N/A | Other specified forms of chronic ischemic heart disease |
| 414.9 | N/A | N/A | Chronic ischemic heart disease, unspecified |
| V45.81 | N/A | N/A | Aortocoronary bypass status |
| V45.82 | N/A | N/A | Percutaneous transluminal coronary angioplasty status |
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| I20.0 | N/A | N/A | Unstable angina |
| I20.1 | N/A | N/A | Angina pectoris with documented spasm |
| I20.8 | N/A | N/A | Other forms of angina pectoris |
| I20.9 | N/A | N/A | Angina pectoris, unspecified |
| I21.01 | N/A | N/A | ST elevation (STEMI) myocardial infarction involving left main coronary artery |
| I21.02 | N/A | N/A | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery |
| I21.09 | N/A | N/A | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall |
| I21.11 | N/A | N/A | ST elevation (STEMI) myocardial infarction involving right coronary artery |
| I21.19 | N/A | N/A | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall |
| I21.21 | N/A | N/A | ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery |
| I21.29 | N/A | N/A | ST elevation (STEMI) myocardial infarction involving other sites |
| I21.3 | N/A | N/A | ST elevation (STEMI) myocardial infarction of unspecified site |
| I21.4 | N/A | N/A | Non-ST elevation (NSTEMI) myocardial infarction |
| I22.0 | N/A | N/A | Subsequent ST elevation (STEMI) myocardial infarction of anterior wall |
| I22.1 | N/A | N/A | Subsequent ST elevation (STEMI) myocardial infarction of inferior wall |
| I22.2 | N/A | N/A | Subsequent non-ST elevation (NSTEMI) myocardial infarction |
| I22.8 | N/A | N/A | Subsequent ST elevation (STEMI) myocardial infarction of other sites |
| I22.9 | N/A | N/A | Subsequent ST elevation (STEMI) myocardial infarction of unspecified site |
| I24.0 | N/A | N/A | Acute coronary thrombosis not resulting in myocardial infarction |
| I24.1 | N/A | N/A | Dressler's syndrome |
| I24.8 | N/A | N/A | Other forms of acute ischemic heart disease |
| I24.9 | N/A | N/A | Acute ischemic heart disease, unspecified |
| I25.10 | N/A | N/A | Atherosclerotic heart disease of native coronary artery without angina pectoris |
| I25.110 | N/A | N/A | Atherosclerotic heart disease of native coronary artery with unstable angina pectoris |
| I25.111 | N/A | N/A | Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm |
| I25.118 | N/A | N/A | Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris |
| I25.119 | N/A | N/A | Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris |
| I25.2 | N/A | N/A | Old myocardial infarction |
| I25.5 | N/A | N/A | Ischemic cardiomyopathy |
| I25.6 | N/A | N/A | Silent myocardial ischemia |
| I25.700 | N/A | N/A | Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris |
| I25.701 | N/A | N/A | Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm |
| I25.708 | N/A | N/A | Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris |
| I25.709 | N/A | N/A | Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris |
| I25.710 | N/A | N/A | Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris |
| I25.711 | N/A | N/A | Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm |
| I25.718 | N/A | N/A | Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris |
| I25.719 | N/A | N/A | Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris |
| I25.720 | N/A | N/A | Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris |
| I25.721 | N/A | N/A | Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm |
| I25.728 | N/A | N/A | Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris |
| I25.729 | N/A | N/A | Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris |
| I25.730 | N/A | N/A | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris |
| I25.731 | N/A | N/A | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm |
| I25.738 | N/A | N/A | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris |
| I25.739 | N/A | N/A | Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris |
| I25.750 | N/A | N/A | Atherosclerosis of native coronary artery of transplanted heart with unstable angina |
| I25.751 | N/A | N/A | Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm |
| I25.758 | N/A | N/A | Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris |
| I25.759 | N/A | N/A | Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris |
| I25.760 | N/A | N/A | Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina |
| I25.761 | N/A | N/A | Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm |
| I25.768 | N/A | N/A | Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris |
| I25.769 | N/A | N/A | Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris |
| I25.790 | N/A | N/A | Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris |
| I25.791 | N/A | N/A | Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm |
| I25.798 | N/A | N/A | Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris |
| I25.799 | N/A | N/A | Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris |
| I25.82 | N/A | N/A | Chronic total occlusion of coronary artery |
| I25.83 | N/A | N/A | Coronary atherosclerosis due to lipid rich plaque |
| I25.89 | N/A | N/A | Other forms of chronic ischemic heart disease |
| I25.9 | N/A | N/A | Chronic ischemic heart disease, unspecified |
| Z95.1 | N/A | N/A | Presence of aortocoronary bypass graft |
| Z95.5 | N/A | N/A | Presence of coronary angioplasty implant and graft |
| Z98.61 | N/A | N/A | Coronary angioplasty status |
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/ACOThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
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/ACOThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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