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PQRS Measure

 Report via: Claim, Registry, GPRO/ACO, Measure Group
 This measure is can be reported as part of the following groups:
 Chronic Obstructive Pulmonary Disease (COPD) Group   

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.
4025F1PN/AInhaled bronchodilator prescribed (COPD)
4025F2PN/AInhaled bronchodilator prescribed (COPD)
4025F3PN/AInhaled bronchodilator prescribed (COPD)
4025FN/AN/AInhaled bronchodilator prescribed (COPD)
4025F8PN/AInhaled bronchodilator prescribed (COPD)

HCPCS Codes

CodeModifierPOSDescription
G8924N/AN/ASpirometry results documented (fev1/fvc < 70%)
G8925N/AN/ASpirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms
G8926N/AN/ASpirometry test not performed or documented, reason not given

ICD9 Codes

CodeModifierPOSDescription
491.0N/AN/ASimple chronic bronchitis
491.1N/AN/AMucopurulent chronic bronchitis
491.20N/AN/AObstructive chronic bronchitis without exacerbation
491.21N/AN/AObstructive chronic bronchitis with (acute) exacerbation
491.22N/AN/AObstructive chronic bronchitis with acute bronchitis
491.8N/AN/AOther chronic bronchitis
491.9N/AN/AUnspecified chronic bronchitis
492.0N/AN/AEmphysematous bleb
492.8N/AN/AOther emphysema
493.20N/AN/AChronic obstructive asthma, unspecified
493.21N/AN/AChronic obstructive asthma with status asthmaticus
493.22N/AN/AChronic obstructive asthma with (acute) exacerbation
496N/AN/AChronic airway obstruction, not elsewhere classified

ICD10CM Codes

CodeModifierPOSDescription
J41.0N/AN/ASimple chronic bronchitis
J41.1N/AN/AMucopurulent chronic bronchitis
J41.8N/AN/AMixed simple and mucopurulent chronic bronchitis
J42N/AN/AUnspecified chronic bronchitis
J43.0N/AN/AUnilateral pulmonary emphysema [MacLeod's syndrome]
J43.1N/AN/APanlobular emphysema
J43.2N/AN/ACentrilobular emphysema
J43.8N/AN/AOther emphysema
J43.9N/AN/AEmphysema, unspecified
J44.0N/AN/AChronic obstructive pulmonary disease with (acute) lower respiratory infection
J44.1N/AN/AChronic obstructive pulmonary disease with (acute) exacerbation
J44.9N/AN/AChronic obstructive pulmonary disease, 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).
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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