PQRS Measure
#71Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
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. | ||
| 3315F | Estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer (ONC) | ||
| 3316F | Estrogen receptor (ER) and progesterone receptor (PR) negative breast cancer (ONC) | ||
| 3316F | 8P | Estrogen receptor (ER) and progesterone receptor (PR) negative breast cancer (ONC) | |
| 3370F | AJCC Breast Cancer Stage 0 documented (ONC) | ||
| 3370F | 8P | AJCC Breast Cancer Stage 0 documented (ONC) | |
| 3372F | AJCC Breast Cancer Stage I: T1mic, T1a or T1b (tumor size <= 1 cm) documented (ONC) | ||
| 3374F | AJCC Breast Cancer Stage I: T1c (tumor size > 1 cm to 2 cm) documented (ONC) | ||
| 3376F | AJCC Breast Cancer Stage II documented (ONC) | ||
| 3378F | AJCC Breast Cancer Stage III documented (ONC) | ||
| 3380F | AJCC Breast Cancer Stage IV documented (ONC) | ||
| 4179F | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | ||
| 4179F | 1P | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | |
| 4179F | 2P | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | |
| 4179F | 3P | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | |
| 4179F | 8P | Tamoxifen or aromatase inhibitor (AI) prescribed (ONC) | |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 174 | |||
| 174.1 | Malignant neoplasm of central portion of female breast | ||
| 174.2 | Malignant neoplasm of upper-inner quadrant of female breast | ||
| 174.3 | Malignant neoplasm of lower-inner quadrant of female breast | ||
| 174.4 | Malignant neoplasm of upper-outer quadrant of female breast | ||
| 174.5 | Malignant neoplasm of lower-outer quadrant of female breast | ||
| 174.6 | Malignant neoplasm of axillary tail of female breast | ||
| 174.8 | Malignant neoplasm of other specified sites of female breast | ||
| 174.9 | Malignant neoplasm of breast (female), unspecified | ||
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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