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PQRS Measure

 This measure may be submitted via Registry only

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
99218Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or 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 problem(s) requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.
99219Initial observation care, per day, for the evaluation and management of a 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 problem(s) requiring admission to outpatient hospital "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit.
99220Initial observation care, per day, for the evaluation and management of a 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 problem(s) requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.
99221Initial hospital inpatient or observation 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 medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
99222Initial hospital inpatient or observation 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, 55 minutes must be met or exceeded.
99223Initial hospital inpatient or observation 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, 75 minutes must be met or exceeded.
99224Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or 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 patient is stable, recovering, or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit.
99225Subsequent observation care, per day, for the evaluation and management of a 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 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 patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.
99226Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; 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 complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.
99231Subsequent hospital inpatient or observation 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.
99232Subsequent hospital inpatient or observation 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.
99233Subsequent hospital inpatient or observation 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.
99281Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
99282Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
99283Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making
99284Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
99285Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making
99291Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

HCPCS Codes

CodeModifierPOSDescription
G8600Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well
G8601Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention)
G8602Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given

ICD10CM Codes

CodeModifierPOSDescription
I63.00Cerebral infarction due to thrombosis of unspecified precerebral artery
I63.011Cerebral infarction due to thrombosis of right vertebral artery
I63.012Cerebral infarction due to thrombosis of left vertebral artery
I63.019Cerebral infarction due to thrombosis of unspecified vertebral artery
I63.02Cerebral infarction due to thrombosis of basilar artery
I63.031Cerebral infarction due to thrombosis of right carotid artery
I63.032Cerebral infarction due to thrombosis of left carotid artery
I63.039Cerebral infarction due to thrombosis of unspecified carotid artery
I63.09Cerebral infarction due to thrombosis of other precerebral artery
I63.10Cerebral infarction due to embolism of unspecified precerebral artery
I63.111Cerebral infarction due to embolism of right vertebral artery
I63.112Cerebral infarction due to embolism of left vertebral artery
I63.119Cerebral infarction due to embolism of unspecified vertebral artery
I63.12Cerebral infarction due to embolism of basilar artery
I63.131Cerebral infarction due to embolism of right carotid artery
I63.132Cerebral infarction due to embolism of left carotid artery
I63.139Cerebral infarction due to embolism of unspecified carotid artery
I63.19Cerebral infarction due to embolism of other precerebral artery
I63.20Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries
I63.211Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery
I63.212Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery
I63.219Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery
I63.22Cerebral infarction due to unspecified occlusion or stenosis of basilar artery
I63.231Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.239Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery
I63.29Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries
I63.30Cerebral infarction due to thrombosis of unspecified cerebral artery
I63.311Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312Cerebral infarction due to thrombosis of left middle cerebral artery
I63.319Cerebral infarction due to thrombosis of unspecified middle cerebral artery
I63.321Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.329Cerebral infarction due to thrombosis of unspecified anterior cerebral artery
I63.331Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.339Cerebral infarction due to thrombosis of unspecified posterior cerebral artery
I63.341Cerebral infarction due to thrombosis of right cerebellar artery
I63.342Cerebral infarction due to thrombosis of left cerebellar artery
I63.349Cerebral infarction due to thrombosis of unspecified cerebellar artery
I63.39Cerebral infarction due to thrombosis of other cerebral artery
I63.40Cerebral infarction due to embolism of unspecified cerebral artery
I63.411Cerebral infarction due to embolism of right middle cerebral artery
I63.412Cerebral infarction due to embolism of left middle cerebral artery
I63.419Cerebral infarction due to embolism of unspecified middle cerebral artery
I63.421Cerebral infarction due to embolism of right anterior cerebral artery
I63.422Cerebral infarction due to embolism of left anterior cerebral artery
I63.429Cerebral infarction due to embolism of unspecified anterior cerebral artery
I63.431Cerebral infarction due to embolism of right posterior cerebral artery
I63.432Cerebral infarction due to embolism of left posterior cerebral artery
I63.439Cerebral infarction due to embolism of unspecified posterior cerebral artery
I63.441Cerebral infarction due to embolism of right cerebellar artery
I63.442Cerebral infarction due to embolism of left cerebellar artery
I63.449Cerebral infarction due to embolism of unspecified cerebellar artery
I63.50Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
I63.511Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.519Cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery
I63.521Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.529Cerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery
I63.531Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.539Cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery
I63.541Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.549Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery
I63.59Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.8Other cerebral infarction
I63.9Cerebral infarction, 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).
GPROThis 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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