PQRS Measure
#9Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 90801 | Psychiatric diagnostic interview examination | ||
| 90802 | Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication | ||
| 90804 | Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; | ||
| 90805 | Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services | ||
| 90806 | Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; | ||
| 90807 | Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services | ||
| 90808 | Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; | ||
| 90809 | Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services | ||
| 90810 | Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; | ||
| 90811 | Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services | ||
| 90812 | Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; | ||
| 90813 | Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services | ||
| 90814 | Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; | ||
| 90815 | Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services | ||
| 90821 | Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; | ||
| 90822 | Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services | ||
| 90823 | Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; | ||
| 90824 | Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient; with medical evaluation and management services | ||
| 90829 | Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient; with medical evaluation and management services | ||
| 90845 | Psychoanalysis | ||
| 90849 | Multiple-family group psychotherapy | ||
| 90853 | Group psychotherapy (other than of a multiple-family group) | ||
| 90857 | Interactive group psychotherapy | ||
| 90862 | Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy | ||
| 99078 | Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) | ||
| 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. | ||
| 99341 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | 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. | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8126 | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase | ||
| G8127 | Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase | ||
| G8128 | Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure | ||
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 296.20 | Major depressive affective disorder, single episode, unspecified | ||
| 296.21 | Major depressive affective disorder, single episode, mild | ||
| 296.22 | Major depressive affective disorder, single episode, moderate | ||
| 296.23 | Major depressive affective disorder, single episode, severe, without mention of psychotic behavior | ||
| 296.24 | Major depressive affective disorder, single episode, severe, specified as with psychotic behavior | ||
| 296.25 | Major depressive affective disorder, single episode, in partial or unspecified remission | ||
| 296.30 | Major depressive affective disorder, recurrent episode, unspecified | ||
| 296.31 | Major depressive affective disorder, recurrent episode, mild | ||
| 296.32 | Major depressive affective disorder, recurrent episode, moderate | ||
| 296.33 | Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior | ||
| 296.34 | Major depressive affective disorder, recurrent episode, severe, specified as with psychotic behavior | ||
| 296.35 | Major depressive affective disorder, recurrent episode, in partial or unspecified remission | ||
| 298.0 | Depressive type psychosis | ||
| 300.4 | Dysthymic disorder | ||
| 309.0 | Adjustment disorder with depressed mood | ||
| 309.1 | Prolonged depressive reaction | ||
| 311 | Depressive disorder, not elsewhere classified | ||
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 IThis measure can be submitted via Group Practice Reporting Option 1.
GPRO IIThis measure can be submitted via Group Practice Reporting Option 2.
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 IThis measure can be submitted via Group Practice Reporting Option 1.
GPRO IIThis measure can be submitted via Group Practice Reporting Option 2.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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