PQRS Information

Year: 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007

PQRS Measure

#109Osteoarthritis (OA): Function and Pain Assessment

Report via: Claim, Registry

The following codes apply for this PQRS measure:

Code	Modifier	POS	Description
CPT Codes
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.
1006F	N/A	N/A	Osteoarthritis symptoms and functional status assessed (may include the use of a standardized scale or the completion of an assessment questionnaire, such as the SF-36, AAOS Hip & Knee Questionnaire) (OA) [Instructions: Report when osteoarthritis is addressed during the patient encounter]
1006F	8P	N/A	Osteoarthritis symptoms and functional status assessed (may include the use of a standardized scale or the completion of an assessment questionnaire, such as the SF-36, AAOS Hip & Knee Questionnaire) (OA) [Instructions: Report when osteoarthritis is addressed during the patient encounter]
ICD9 Codes
Code	Modifier	POS	Description
715.00	N/A	N/A	Osteoarthrosis, generalized, site unspecified
715.04	N/A	N/A	Osteoarthrosis, generalized, hand
715.09	N/A	N/A	Osteoarthrosis, generalized, multiple sites
715.10	N/A	N/A	Osteoarthrosis, localized, primary, site unspecified
715.11	N/A	N/A	Osteoarthrosis, localized, primary, shoulder region
715.12	N/A	N/A	Osteoarthrosis, localized, primary, upper arm
715.13	N/A	N/A	Osteoarthrosis, localized, primary, forearm
715.14	N/A	N/A	Osteoarthrosis, localized, primary, hand
715.15	N/A	N/A	Osteoarthrosis, localized, primary, pelvic region and thigh
715.16	N/A	N/A	Osteoarthrosis, localized, primary, lower leg
715.17	N/A	N/A	Osteoarthrosis, localized, primary, ankle and foot
715.18	N/A	N/A	Osteoarthrosis, localized, primary, other specified sites
715.20	N/A	N/A	Osteoarthrosis, localized, secondary, site unspecified
715.21	N/A	N/A	Osteoarthrosis, localized, secondary, shoulder region
715.22	N/A	N/A	Osteoarthrosis, localized, secondary, upper arm
715.23	N/A	N/A	Osteoarthrosis, localized, secondary, forearm
715.24	N/A	N/A	Osteoarthrosis, localized, secondary, hand
715.25	N/A	N/A	Osteoarthrosis, localized, secondary, pelvic region and thigh
715.26	N/A	N/A	Osteoarthrosis, localized, secondary, lower leg
715.27	N/A	N/A	Osteoarthrosis, localized, secondary, ankle and foot
715.28	N/A	N/A	Osteoarthrosis, localized, secondary, other specified sites
715.30	N/A	N/A	Osteoarthrosis, localized, not specified whether primary or secondary, site unspecified
715.31	N/A	N/A	Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region
715.32	N/A	N/A	Osteoarthrosis, localized, not specified whether primary or secondary, upper arm
715.33	N/A	N/A	Osteoarthrosis, localized, not specified whether primary or secondary, forearm
715.34	N/A	N/A	Osteoarthrosis, localized, not specified whether primary or secondary, hand
715.35	N/A	N/A	Osteoarthrosis, localized, not specified whether primary or secondary, pelvic region and thigh
715.36	N/A	N/A	Osteoarthrosis, localized, not specified whether primary or secondary, lower leg
715.37	N/A	N/A	Osteoarthrosis, localized, not specified whether primary or secondary, ankle and foot
715.38	N/A	N/A	Osteoarthrosis, localized, not specified whether primary or secondary, other specified sites
715.80	N/A	N/A	Osteoarthrosis involving, or with mention of more than one site, but not specified as generalized, site unspecified
715.89	N/A	N/A	Osteoarthrosis involving, or with mention of more than one site, but not specified as generalized, multiple sites
715.90	N/A	N/A	Osteoarthrosis, unspecified whether generalized or localized, site unspecified
715.91	N/A	N/A	Osteoarthrosis, unspecified whether generalized or localized, shoulder region
715.92	N/A	N/A	Osteoarthrosis, unspecified whether generalized or localized, upper arm
715.93	N/A	N/A	Osteoarthrosis, unspecified whether generalized or localized, forearm
715.94	N/A	N/A	Osteoarthrosis, unspecified whether generalized or localized, hand
715.95	N/A	N/A	Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh
715.96	N/A	N/A	Osteoarthrosis, unspecified whether generalized or localized, lower leg
715.97	N/A	N/A	Osteoarthrosis, unspecified whether generalized or localized, ankle and foot
715.98	N/A	N/A	Osteoarthrosis, unspecified whether generalized or localized, other specified sites
ICD10CM Codes
Code	Modifier	POS	Description
M15.0	N/A	N/A	Primary generalized (osteo)arthritis
M15.1	N/A	N/A	Heberden's nodes (with arthropathy)
M15.2	N/A	N/A	Bouchard's nodes (with arthropathy)
M15.3	N/A	N/A	Secondary multiple arthritis
M15.4	N/A	N/A	Erosive (osteo)arthritis
M15.8	N/A	N/A	Other polyosteoarthritis
M15.9	N/A	N/A	Polyosteoarthritis, unspecified
M16.0	N/A	N/A	Bilateral primary osteoarthritis of hip
M16.10	N/A	N/A	Unilateral primary osteoarthritis, unspecified hip
M16.11	N/A	N/A	Unilateral primary osteoarthritis, right hip
M16.12	N/A	N/A	Unilateral primary osteoarthritis, left hip
M16.2	N/A	N/A	Bilateral osteoarthritis resulting from hip dysplasia
M16.30	N/A	N/A	Unilateral osteoarthritis resulting from hip dysplasia, unspecified hip
M16.31	N/A	N/A	Unilateral osteoarthritis resulting from hip dysplasia, right hip
M16.32	N/A	N/A	Unilateral osteoarthritis resulting from hip dysplasia, left hip
M16.4	N/A	N/A	Bilateral post-traumatic osteoarthritis of hip
M16.50	N/A	N/A	Unilateral post-traumatic osteoarthritis, unspecified hip
M16.51	N/A	N/A	Unilateral post-traumatic osteoarthritis, right hip
M16.52	N/A	N/A	Unilateral post-traumatic osteoarthritis, left hip
M16.6	N/A	N/A	Other bilateral secondary osteoarthritis of hip
M16.7	N/A	N/A	Other unilateral secondary osteoarthritis of hip
M16.9	N/A	N/A	Osteoarthritis of hip, unspecified
M17.0	N/A	N/A	Bilateral primary osteoarthritis of knee
M17.10	N/A	N/A	Unilateral primary osteoarthritis, unspecified knee
M17.11	N/A	N/A	Unilateral primary osteoarthritis, right knee
M17.12	N/A	N/A	Unilateral primary osteoarthritis, left knee
M17.2	N/A	N/A	Bilateral post-traumatic osteoarthritis of knee
M17.30	N/A	N/A	Unilateral post-traumatic osteoarthritis, unspecified knee
M17.31	N/A	N/A	Unilateral post-traumatic osteoarthritis, right knee
M17.32	N/A	N/A	Unilateral post-traumatic osteoarthritis, left knee
M17.4	N/A	N/A	Other bilateral secondary osteoarthritis of knee
M17.5	N/A	N/A	Other unilateral secondary osteoarthritis of knee
M17.9	N/A	N/A	Osteoarthritis of knee, unspecified
M18.0	N/A	N/A	Bilateral primary osteoarthritis of first carpometacarpal joints
M18.10	N/A	N/A	Unilateral primary osteoarthritis of first carpometacarpal joint, unspecified hand
M18.11	N/A	N/A	Unilateral primary osteoarthritis of first carpometacarpal joint, right hand
M18.12	N/A	N/A	Unilateral primary osteoarthritis of first carpometacarpal joint, left hand
M18.2	N/A	N/A	Bilateral post-traumatic osteoarthritis of first carpometacarpal joints
M18.30	N/A	N/A	Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, unspecified hand
M18.31	N/A	N/A	Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, right hand
M18.32	N/A	N/A	Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, left hand
M18.4	N/A	N/A	Other bilateral secondary osteoarthritis of first carpometacarpal joints
M18.50	N/A	N/A	Other unilateral secondary osteoarthritis of first carpometacarpal joint, unspecified hand
M18.51	N/A	N/A	Other unilateral secondary osteoarthritis of first carpometacarpal joint, right hand
M18.52	N/A	N/A	Other unilateral secondary osteoarthritis of first carpometacarpal joint, left hand
M18.9	N/A	N/A	Osteoarthritis of first carpometacarpal joint, unspecified
M19.011	N/A	N/A	Primary osteoarthritis, right shoulder
M19.012	N/A	N/A	Primary osteoarthritis, left shoulder
M19.019	N/A	N/A	Primary osteoarthritis, unspecified shoulder
M19.021	N/A	N/A	Primary osteoarthritis, right elbow
M19.022	N/A	N/A	Primary osteoarthritis, left elbow
M19.029	N/A	N/A	Primary osteoarthritis, unspecified elbow
M19.031	N/A	N/A	Primary osteoarthritis, right wrist
M19.032	N/A	N/A	Primary osteoarthritis, left wrist
M19.039	N/A	N/A	Primary osteoarthritis, unspecified wrist
M19.041	N/A	N/A	Primary osteoarthritis, right hand
M19.042	N/A	N/A	Primary osteoarthritis, left hand
M19.049	N/A	N/A	Primary osteoarthritis, unspecified hand
M19.071	N/A	N/A	Primary osteoarthritis, right ankle and foot
M19.072	N/A	N/A	Primary osteoarthritis, left ankle and foot
M19.079	N/A	N/A	Primary osteoarthritis, unspecified ankle and foot
M19.111	N/A	N/A	Post-traumatic osteoarthritis, right shoulder
M19.112	N/A	N/A	Post-traumatic osteoarthritis, left shoulder
M19.119	N/A	N/A	Post-traumatic osteoarthritis, unspecified shoulder
M19.121	N/A	N/A	Post-traumatic osteoarthritis, right elbow
M19.122	N/A	N/A	Post-traumatic osteoarthritis, left elbow
M19.129	N/A	N/A	Post-traumatic osteoarthritis, unspecified elbow
M19.131	N/A	N/A	Post-traumatic osteoarthritis, right wrist
M19.132	N/A	N/A	Post-traumatic osteoarthritis, left wrist
M19.139	N/A	N/A	Post-traumatic osteoarthritis, unspecified wrist
M19.141	N/A	N/A	Post-traumatic osteoarthritis, right hand
M19.142	N/A	N/A	Post-traumatic osteoarthritis, left hand
M19.149	N/A	N/A	Post-traumatic osteoarthritis, unspecified hand
M19.171	N/A	N/A	Post-traumatic osteoarthritis, right ankle and foot
M19.172	N/A	N/A	Post-traumatic osteoarthritis, left ankle and foot
M19.179	N/A	N/A	Post-traumatic osteoarthritis, unspecified ankle and foot
M19.211	N/A	N/A	Secondary osteoarthritis, right shoulder
M19.212	N/A	N/A	Secondary osteoarthritis, left shoulder
M19.219	N/A	N/A	Secondary osteoarthritis, unspecified shoulder
M19.221	N/A	N/A	Secondary osteoarthritis, right elbow
M19.222	N/A	N/A	Secondary osteoarthritis, left elbow
M19.229	N/A	N/A	Secondary osteoarthritis, unspecified elbow
M19.231	N/A	N/A	Secondary osteoarthritis, right wrist
M19.232	N/A	N/A	Secondary osteoarthritis, left wrist
M19.239	N/A	N/A	Secondary osteoarthritis, unspecified wrist
M19.241	N/A	N/A	Secondary osteoarthritis, right hand
M19.242	N/A	N/A	Secondary osteoarthritis, left hand
M19.249	N/A	N/A	Secondary osteoarthritis, unspecified hand
M19.271	N/A	N/A	Secondary osteoarthritis, right ankle and foot
M19.272	N/A	N/A	Secondary osteoarthritis, left ankle and foot
M19.279	N/A	N/A	Secondary osteoarthritis, unspecified ankle and foot
M19.90	N/A	N/A	Unspecified osteoarthritis, unspecified site
M19.91	N/A	N/A	Primary osteoarthritis, unspecified site
M19.92	N/A	N/A	Post-traumatic osteoarthritis, unspecified site
M19.93	N/A	N/A	Secondary osteoarthritis, unspecified site

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.

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