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PQRS Measure

#118Angiotensin Converting Enzyme Inhibitor (ACE) or Angiotensin Receptor Blocker (ARB) Therapy for Patients with Coronary Artery Disease and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD)
 Description/Specifications Data Collection Sheet 

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
99201Office 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.
99202Office 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.
99203Office 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.
99204Office 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.
99205Office 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.
99212Office 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.
99213Office 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.
99214Office 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.
99215Office 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.
99241Office consultation for a new or established 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 self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99242Office or other outpatient consultation for a new or 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.
99243Office or other outpatient consultation for a new or 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.
99244Office or other outpatient consultation for a new or 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.
99245Office or other outpatient consultation for a new or 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, 55 minutes must be met or exceeded.
99304Initial 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.
99305Initial 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.
99306Initial 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.
99307Subsequent 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.
99308Subsequent 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.
99309Subsequent 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.
99310Subsequent 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.
99324Domiciliary 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.
99325Domiciliary 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.
99326Domiciliary 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.
99327Domiciliary 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.
99328Domiciliary 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.
99334Domiciliary 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.
99335Domiciliary 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.
99336Domiciliary 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.
99337Domiciliary 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.
99341Home 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.
99342Home 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.
99343Home 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.
99344Home 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.
99345Home 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.
99347Home 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.
99348Home 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.
99349Home 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.
99350Home 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

CodeModifierPOSDescription
G8468Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed for patients with a left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function
G8469Clinician documented that patient with a left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
G8470Patient with left ventricular ejection fraction (lvef) >=40% or documentation as normal or mildly depressed left ventricular systolic function
G8471Left ventricular ejection fraction (lvef) was not performed or documented
G8472Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for patients with a left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function, reason not specified
G8473Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed
G8474Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons)
G8475Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given

ICD9 Codes

CodeModifierPOSDescription
250.00Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
250.01Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled
250.02Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled
250.03Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled
250.10Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled
250.11Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled
250.12Diabetes with ketoacidosis, type II or unspecified type, uncontrolled
250.13Diabetes with ketoacidosis, type I [juvenile type], uncontrolled
250.20Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled
250.21Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled
250.22Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled
250.23Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled
250.30Diabetes with other coma, type II or unspecified type, not stated as uncontrolled
250.31Diabetes with other coma, type I [juvenile type], not stated as uncontrolled
250.32Diabetes with other coma, type II or unspecified type, uncontrolled
250.33Diabetes with other coma, type I [juvenile type], uncontrolled
250.40Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled
250.41Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled
250.42Diabetes with renal manifestations, type II or unspecified type, uncontrolled
250.43Diabetes with renal manifestations, type I [juvenile type], uncontrolled
250.50Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled
250.51Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled
250.52Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled
250.53Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled
250.60Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled
250.61Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled
250.62Diabetes with neurological manifestations, type II or unspecified type, uncontrolled
250.63Diabetes with neurological manifestations, type I [juvenile type], uncontrolled
250.70Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled
250.71Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled
250.72Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled
250.73Diabetes with peripheral circulatory disorders, type I [juvenile type], uncontrolled
250.80Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled
250.81Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled
250.82Diabetes with other specified manifestations, type II or unspecified type, uncontrolled
250.83Diabetes with other specified manifestations, type I [juvenile type], uncontrolled
250.90Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled
250.91Diabetes with unspecified complication, type I [juvenile type], not stated as uncontrolled
250.92Diabetes with unspecified complication, type II or unspecified type, uncontrolled
250.93Diabetes with unspecified complication, type I [juvenile type], uncontrolled
410.00Acute myocardial infarction of anterolateral wall, episode of care unspecified
410.01Acute myocardial infarction of anterolateral wall, initial episode of care
410.02Acute myocardial infarction of anterolateral wall, subsequent episode of care
410.10Acute myocardial infarction of other anterior wall, episode of care unspecified
410.11Acute myocardial infarction of other anterior wall, initial episode of care
410.12Acute myocardial infarction of other anterior wall, subsequent episode of care
410.20Acute myocardial infarction of inferolateral wall, episode of care unspecified
410.21Acute myocardial infarction of inferolateral wall, initial episode of care
410.22Acute myocardial infarction of inferolateral wall, subsequent episode of care
410.30Acute myocardial infarction of inferoposterior wall, episode of care unspecified
410.31Acute myocardial infarction of inferoposterior wall, initial episode of care
410.32Acute myocardial infarction of inferoposterior wall, subsequent episode of care
410.40Acute myocardial infarction of other inferior wall, episode of care unspecified
410.41Acute myocardial infarction of other inferior wall, initial episode of care
410.42Acute myocardial infarction of other inferior wall, subsequent episode of care
410.50Acute myocardial infarction of other lateral wall, episode of care unspecified
410.51Acute myocardial infarction of other lateral wall, initial episode of care
410.52Acute myocardial infarction of other lateral wall, subsequent episode of care
410.60True posterior wall infarction, episode of care unspecified
410.61True posterior wall infarction, initial episode of care
410.62True posterior wall infarction, subsequent episode of care
410.70Subendocardial infarction, episode of care unspecified
410.71Subendocardial infarction, initial episode of care
410.72Subendocardial infarction, subsequent episode of care
410.80Acute myocardial infarction of other specified sites, episode of care unspecified
410.81Acute myocardial infarction of other specified sites, initial episode of care
410.82Acute myocardial infarction of other specified sites, subsequent episode of care
410.90Acute myocardial infarction of unspecified site, episode of care unspecified
410.91Acute myocardial infarction of unspecified site, initial episode of care
410.92Acute myocardial infarction of unspecified site, subsequent episode of care
411.0Postmyocardial infarction syndrome
411.1Intermediate coronary syndrome
411.81Acute coronary occlusion without myocardial infarction
411.89Other acute and subacute forms of ischemic heart disease, other
413.0Angina decubitus
413.1Prinzmetal angina
413.9Other and unspecified angina pectoris
414.00Coronary atherosclerosis of unspecified type of vessel, native or graft
414.01Coronary atherosclerosis of native coronary artery
414.02Coronary atherosclerosis of autologous vein bypass graft
414.03Coronary atherosclerosis of nonautologous biological bypass graft
414.04Coronary atherosclerosis of artery bypass graft
414.05Coronary atherosclerosis of unspecified bypass graft
414.06Coronary atherosclerosis of native coronary artery of transplanted heart
414.07Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
414.8Other specified forms of chronic ischemic heart disease
414.9Chronic ischemic heart disease, unspecified
648.00Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable
648.01Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition
648.02Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication
648.03Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication
648.04Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication
V45.81Aortocoronary bypass status
V45.81Aortocoronary bypass status
V45.82Percutaneous transluminal coronary angioplasty status
V45.82Percutaneous transluminal coronary angioplasty status
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.
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