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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
99201N/AN/AOffice 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.
99202N/AN/AOffice 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.
99203N/AN/AOffice 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.
99204N/AN/AOffice 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.
99205N/AN/AOffice 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.
99212N/AN/AOffice 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.
99213N/AN/AOffice 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.
99214N/AN/AOffice 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.
99215N/AN/AOffice 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.
99387N/AN/AInitial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
99395N/AN/APeriodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
99396N/AN/APeriodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
G0438N/AN/A
G0439N/AN/A
33361N/AN/ATranscatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach
33362N/AN/ATranscatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach
33363N/AN/ATranscatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach
33364N/AN/ATranscatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach
33365N/AN/ATranscatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy)
33400N/AN/AValvuloplasty, aortic valve; open, with cardiopulmonary bypass
33401N/AN/AValvuloplasty, aortic valve; open, with inflow occlusion
33403N/AN/AValvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass
33404N/AN/AConstruction of apical-aortic conduit
33405N/AN/AReplacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve
33406N/AN/AReplacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand)
33410N/AN/AReplacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve
33411N/AN/AReplacement, aortic valve; with aortic annulus enlargement, noncoronary sinus
33412N/AN/AReplacement, aortic valve; with transventricular aortic annulus enlargement (Konno procedure)
33413N/AN/AReplacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure)
33414N/AN/ARepair of left ventricular outflow tract obstruction by patch enlargement of the outflow tract
33415N/AN/AResection or incision of subvalvular tissue for discrete subvalvular aortic stenosis
33416N/AN/AVentriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic stenosis (eg, asymmetric septal hypertrophy)
33417N/AN/AAortoplasty (gusset) for supravalvular stenosis
33420N/AN/AValvotomy, mitral valve; closed heart
33422N/AN/AValvotomy, mitral valve; open heart, with cardiopulmonary bypass
33425N/AN/AValvuloplasty, mitral valve, with cardiopulmonary bypass;
33426N/AN/AValvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring
33427N/AN/AValvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring
33430N/AN/AReplacement, mitral valve, with cardiopulmonary bypass
33463N/AN/AValvuloplasty, tricuspid valve; without ring insertion
33464N/AN/AValvuloplasty, tricuspid valve; with ring insertion
33465N/AN/AReplacement, tricuspid valve, with cardiopulmonary bypass
33468N/AN/ATricuspid valve repositioning and plication for Ebstein anomaly
33470N/AN/AValvotomy, pulmonary valve, closed heart; transventricular
33471N/AN/AValvotomy, pulmonary valve, closed heart, via pulmonary artery
33472N/AN/AValvotomy, pulmonary valve, open heart; with inflow occlusion
33474N/AN/AValvotomy, pulmonary valve, open heart, with cardiopulmonary bypass
33475N/AN/AReplacement, pulmonary valve
33476N/AN/ARight ventricular resection for infundibular stenosis, with or without commissurotomy
33478N/AN/AOutflow tract augmentation (gusset), with or without commissurotomy or infundibular resection
33496N/AN/ARepair of non-structural prosthetic valve dysfunction with cardiopulmonary bypass (separate procedure)
33510N/AN/ACoronary artery bypass, vein only; single coronary venous graft
33511N/AN/ACoronary artery bypass, vein only; 2 coronary venous grafts
33512N/AN/ACoronary artery bypass, vein only; 3 coronary venous grafts
33513N/AN/ACoronary artery bypass, vein only; 4 coronary venous grafts
33514N/AN/ACoronary artery bypass, vein only; 5 coronary venous grafts
33516N/AN/ACoronary artery bypass, vein only; 6 or more coronary venous grafts
33517N/AN/ACoronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure)
33518N/AN/ACoronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure)
33519N/AN/ACoronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (List separately in addition to code for primary procedure)
33521N/AN/ACoronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (List separately in addition to code for primary procedure)
33522N/AN/ACoronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (List separately in addition to code for primary procedure)
33523N/AN/ACoronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (List separately in addition to code for primary procedure)
33530N/AN/AReoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (List separately in addition to code for primary procedure)
33533N/AN/ACoronary artery bypass, using arterial graft(s); single arterial graft
33534N/AN/ACoronary artery bypass, using arterial graft(s); 2 coronary arterial grafts
33535N/AN/ACoronary artery bypass, using arterial graft(s); 3 coronary arterial grafts
33536N/AN/ACoronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts
33572N/AN/ACoronary endarterectomy, open, any method, of left anterior descending, circumflex, or right coronary artery performed in conjunction with coronary artery bypass graft procedure, each vessel (List separately in addition to primary procedure)
33600N/AN/AClosure of atrioventricular valve (mitral or tricuspid) by suture or patch
33602N/AN/AClosure of semilunar valve (aortic or pulmonary) by suture or patch
33935N/AN/AHeart-lung transplant with recipient cardiectomy-pneumonectomy
33945N/AN/AHeart transplant, with or without recipient cardiectomy
33999N/AN/AUnlisted procedure, cardiac surgery
35500N/AN/AHarvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure)
35600N/AN/AHarvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open
92920N/AN/APercutaneous transluminal coronary angioplasty; single major coronary artery or branch
92924N/AN/APercutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch
92928N/AN/APercutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
92933N/AN/APercutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch
92937N/AN/APercutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel
92941N/AN/APercutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel
92943N/AN/APercutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel
G0290N/AN/A
G0291N/AN/A
1460FN/AN/AQualifying cardiac event/diagnosis in previous 12 months (CAD)
4500FN/AN/AReferred to an outpatient cardiac rehabilitation program (CAD)
4500F1PN/AReferred to an outpatient cardiac rehabilitation program (CAD)
4500F2PN/AReferred to an outpatient cardiac rehabilitation program (CAD)
4500F3PN/AReferred to an outpatient cardiac rehabilitation program (CAD)
4500F8PN/AReferred to an outpatient cardiac rehabilitation program (CAD)
4510FN/AN/APrevious cardiac rehabilitation for qualifying cardiac event completed (CAD)

ICD9 Codes

CodeModifierPOSDescription
410.00N/AN/AAcute myocardial infarction of anterolateral wall, episode of care unspecified
410.01N/AN/AAcute myocardial infarction of anterolateral wall, initial episode of care
410.02N/AN/AAcute myocardial infarction of anterolateral wall, subsequent episode of care
410.10N/AN/AAcute myocardial infarction of other anterior wall, episode of care unspecified
410.11N/AN/AAcute myocardial infarction of other anterior wall, initial episode of care
410.12N/AN/AAcute myocardial infarction of other anterior wall, subsequent episode of care
410.20N/AN/AAcute myocardial infarction of inferolateral wall, episode of care unspecified
410.21N/AN/AAcute myocardial infarction of inferolateral wall, initial episode of care
410.22N/AN/AAcute myocardial infarction of inferolateral wall, subsequent episode of care
410.30N/AN/AAcute myocardial infarction of inferoposterior wall, episode of care unspecified
410.31N/AN/AAcute myocardial infarction of inferoposterior wall, initial episode of care
410.32N/AN/AAcute myocardial infarction of inferoposterior wall, subsequent episode of care
410.40N/AN/AAcute myocardial infarction of other inferior wall, episode of care unspecified
410.41N/AN/AAcute myocardial infarction of other inferior wall, initial episode of care
410.42N/AN/AAcute myocardial infarction of other inferior wall, subsequent episode of care
410.50N/AN/AAcute myocardial infarction of other lateral wall, episode of care unspecified
410.51N/AN/AAcute myocardial infarction of other lateral wall, initial episode of care
410.52N/AN/AAcute myocardial infarction of other lateral wall, subsequent episode of care
410.60N/AN/ATrue posterior wall infarction, episode of care unspecified
410.61N/AN/ATrue posterior wall infarction, initial episode of care
410.62N/AN/ATrue posterior wall infarction, subsequent episode of care
410.70N/AN/ASubendocardial infarction, episode of care unspecified
410.71N/AN/ASubendocardial infarction, initial episode of care
410.72N/AN/ASubendocardial infarction, subsequent episode of care
410.80N/AN/AAcute myocardial infarction of other specified sites, episode of care unspecified
410.81N/AN/AAcute myocardial infarction of other specified sites, initial episode of care
410.82N/AN/AAcute myocardial infarction of other specified sites, subsequent episode of care
410.90N/AN/AAcute myocardial infarction of unspecified site, episode of care unspecified
410.91N/AN/AAcute myocardial infarction of unspecified site, initial episode of care
410.92N/AN/AAcute myocardial infarction of unspecified site, subsequent episode of care
412N/AN/AOld myocardial infarction
413.0N/AN/AAngina decubitus
413.1N/AN/APrinzmetal angina
413.9N/AN/AOther and unspecified angina pectoris

ICD10CM Codes

CodeModifierPOSDescription
I20.1N/AN/AAngina pectoris with documented spasm
I20.8N/AN/AOther forms of angina pectoris
I20.9N/AN/AAngina pectoris, unspecified
121.01N/AN/A
121.02N/AN/A
I21.09N/AN/AST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11N/AN/AST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19N/AN/AST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21N/AN/AST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29N/AN/AST elevation (STEMI) myocardial infarction involving other sites
I21.3N/AN/AST elevation (STEMI) myocardial infarction of unspecified site
I21.4N/AN/ANon-ST elevation (NSTEMI) myocardial infarction
122.0N/AN/A
122.1N/AN/A
122.2N/AN/A
122.8N/AN/A
122.9N/AN/A
I25.2N/AN/AOld myocardial infarction
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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