PQRS Measure
#118Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction (LSVD)
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. | ||
| 99241 | Office 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. | ||
| 99242 | Office 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. | ||
| 99243 | Office 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. | ||
| 99244 | Office 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. | ||
| 99245 | Office 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. | ||
| 99304 | Initial 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. | ||
| 99305 | Initial 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. | ||
| 99306 | Initial 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. | ||
| 99307 | Subsequent 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. | ||
| 99308 | Subsequent 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. | ||
| 99309 | Subsequent 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. | ||
| 99310 | Subsequent 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. | ||
| 99324 | Domiciliary 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. | ||
| 99325 | Domiciliary 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. | ||
| 99326 | Domiciliary 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. | ||
| 99327 | Domiciliary 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. | ||
| 99328 | Domiciliary 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. | ||
| 99334 | Domiciliary 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. | ||
| 99335 | Domiciliary 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. | ||
| 99336 | Domiciliary 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. | ||
| 99337 | Domiciliary 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. | ||
| 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 |
| G8468 | Angiotensin 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 | ||
| G8469 | Clinician 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 | ||
| G8470 | Patient with left ventricular ejection fraction (lvef) >=40% or documentation as normal or mildly depressed left ventricular systolic function | ||
| G8471 | Left ventricular ejection fraction (lvef) was not performed or documented | ||
| G8472 | Angiotensin 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 | ||
| G8473 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed | ||
| G8474 | Angiotensin 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) | ||
| G8475 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given | ||
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 250 | |||
| 250.01 | Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled | ||
| 250.02 | Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled | ||
| 250.03 | Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled | ||
| 250.1 | |||
| 250.11 | Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled | ||
| 250.12 | Diabetes with ketoacidosis, type II or unspecified type, uncontrolled | ||
| 250.13 | Diabetes with ketoacidosis, type I [juvenile type], uncontrolled | ||
| 250.2 | |||
| 250.21 | Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled | ||
| 250.22 | Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled | ||
| 250.23 | Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled | ||
| 250.3 | |||
| 250.31 | Diabetes with other coma, type I [juvenile type], not stated as uncontrolled | ||
| 250.32 | Diabetes with other coma, type II or unspecified type, uncontrolled | ||
| 250.33 | Diabetes with other coma, type I [juvenile type], uncontrolled | ||
| 250.4 | |||
| 250.41 | Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled | ||
| 250.42 | Diabetes with renal manifestations, type II or unspecified type, uncontrolled | ||
| 250.43 | Diabetes with renal manifestations, type I [juvenile type], uncontrolled | ||
| 250.5 | |||
| 250.51 | Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled | ||
| 250.52 | Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled | ||
| 250.53 | Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled | ||
| 250.6 | |||
| 250.61 | Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled | ||
| 250.62 | Diabetes with neurological manifestations, type II or unspecified type, uncontrolled | ||
| 250.63 | Diabetes with neurological manifestations, type I [juvenile type], uncontrolled | ||
| 250.7 | |||
| 250.71 | Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled | ||
| 250.72 | Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled | ||
| 250.73 | Diabetes with peripheral circulatory disorders, type I [juvenile type], uncontrolled | ||
| 250.8 | |||
| 250.81 | Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled | ||
| 250.82 | Diabetes with other specified manifestations, type II or unspecified type, uncontrolled | ||
| 250.83 | Diabetes with other specified manifestations, type I [juvenile type], uncontrolled | ||
| 250.9 | |||
| 250.91 | Diabetes with unspecified complication, type I [juvenile type], not stated as uncontrolled | ||
| 250.92 | Diabetes with unspecified complication, type II or unspecified type, uncontrolled | ||
| 250.93 | Diabetes with unspecified complication, type I [juvenile type], uncontrolled | ||
| 410 | |||
| 410.01 | Acute myocardial infarction of anterolateral wall, initial episode of care | ||
| 410.02 | Acute myocardial infarction of anterolateral wall, subsequent episode of care | ||
| 410.1 | |||
| 410.11 | Acute myocardial infarction of other anterior wall, initial episode of care | ||
| 410.12 | Acute myocardial infarction of other anterior wall, subsequent episode of care | ||
| 410.2 | |||
| 410.21 | Acute myocardial infarction of inferolateral wall, initial episode of care | ||
| 410.22 | Acute myocardial infarction of inferolateral wall, subsequent episode of care | ||
| 410.3 | |||
| 410.31 | Acute myocardial infarction of inferoposterior wall, initial episode of care | ||
| 410.32 | Acute myocardial infarction of inferoposterior wall, subsequent episode of care | ||
| 410.4 | |||
| 410.41 | Acute myocardial infarction of other inferior wall, initial episode of care | ||
| 410.42 | Acute myocardial infarction of other inferior wall, subsequent episode of care | ||
| 410.5 | |||
| 410.51 | Acute myocardial infarction of other lateral wall, initial episode of care | ||
| 410.52 | Acute myocardial infarction of other lateral wall, subsequent episode of care | ||
| 410.6 | |||
| 410.61 | True posterior wall infarction, initial episode of care | ||
| 410.62 | True posterior wall infarction, subsequent episode of care | ||
| 410.7 | |||
| 410.71 | Subendocardial infarction, initial episode of care | ||
| 410.72 | Subendocardial infarction, subsequent episode of care | ||
| 410.8 | |||
| 410.81 | Acute myocardial infarction of other specified sites, initial episode of care | ||
| 410.82 | Acute myocardial infarction of other specified sites, subsequent episode of care | ||
| 410.9 | |||
| 410.91 | Acute myocardial infarction of unspecified site, initial episode of care | ||
| 410.92 | Acute myocardial infarction of unspecified site, subsequent episode of care | ||
| 411 | |||
| 411.1 | Intermediate coronary syndrome | ||
| 411.81 | Acute coronary occlusion without myocardial infarction | ||
| 411.89 | Other acute and subacute forms of ischemic heart disease, other | ||
| 412 | Old myocardial infarction | ||
| 413 | |||
| 413.1 | Prinzmetal angina | ||
| 413.9 | Other and unspecified angina pectoris | ||
| 414 | |||
| 414.01 | Coronary atherosclerosis of native coronary artery | ||
| 414.02 | Coronary atherosclerosis of autologous vein bypass graft | ||
| 414.03 | Coronary atherosclerosis of nonautologous biological bypass graft | ||
| 414.04 | Coronary atherosclerosis of artery bypass graft | ||
| 414.05 | Coronary atherosclerosis of unspecified bypass graft | ||
| 414.06 | Coronary atherosclerosis of native coronary artery of transplanted heart | ||
| 414.07 | Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart | ||
| 414.8 | Other specified forms of chronic ischemic heart disease | ||
| 414.9 | Chronic ischemic heart disease, unspecified | ||
| 648 | |||
| 648.01 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition | ||
| 648.02 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication | ||
| 648.03 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication | ||
| 648.04 | Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication | ||
| V45.81 | Aortocoronary bypass status | ||
| V45.82 | Percutaneous 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.
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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