PQRS Measure
Report via: Claim, Registry, EHR, Measure 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. |
| 3382F | N/A | N/A | AJCC colon cancer, Stage 0 documented (ONC) |
| 3382F | 8P | N/A | AJCC colon cancer, Stage 0 documented (ONC) |
| 3384F | N/A | N/A | AJCC colon cancer, Stage I documented (ONC) |
| 3386F | N/A | N/A | AJCC colon cancer, Stage II documented (ONC) |
| 3388F | N/A | N/A | AJCC colon cancer, Stage III documented (ONC) |
| 3388F | N/A | N/A | AJCC colon cancer, Stage III documented (ONC) |
| 3388F | N/A | N/A | AJCC colon cancer, Stage III documented (ONC) |
| 3388F | N/A | N/A | AJCC colon cancer, Stage III documented (ONC) |
| 3390F | N/A | N/A | AJCC colon cancer, Stage IV documented (ONC) |
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8927 | N/A | N/A | Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer |
| G8927 | N/A | N/A | Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer |
| G8928 | N/A | N/A | Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons) |
| G8928 | N/A | N/A | Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons) |
| G8929 | N/A | N/A | Adjuvant chemotherapy not prescribed or previously received, reason not given |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 153.0 | N/A | N/A | Malignant neoplasm of hepatic flexure |
| 153.1 | N/A | N/A | Malignant neoplasm of transverse colon |
| 153.2 | N/A | N/A | Malignant neoplasm of descending colon |
| 153.3 | N/A | N/A | Malignant neoplasm of sigmoid colon |
| 153.4 | N/A | N/A | Malignant neoplasm of cecum |
| 153.6 | N/A | N/A | Malignant neoplasm of ascending colon |
| 153.7 | N/A | N/A | Malignant neoplasm of splenic flexure |
| 153.8 | N/A | N/A | Malignant neoplasm of other specified sites of large intestine |
| 153.9 | N/A | N/A | Malignant neoplasm of colon, unspecified site |
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| C18.0 | N/A | N/A | Malignant neoplasm of cecum |
| C18.2 | N/A | N/A | Malignant neoplasm of ascending colon |
| C18.3 | N/A | N/A | Malignant neoplasm of hepatic flexure |
| C18.4 | N/A | N/A | Malignant neoplasm of transverse colon |
| C18.5 | N/A | N/A | Malignant neoplasm of splenic flexure |
| C18.6 | N/A | N/A | Malignant neoplasm of descending colon |
| C18.7 | N/A | N/A | Malignant neoplasm of sigmoid colon |
| C18.8 | N/A | N/A | Malignant neoplasm of overlapping sites of colon |
| C18.9 | N/A | N/A | Malignant neoplasm of colon, 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).
GPRO/ACOThis 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).
GPRO/ACOThis 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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