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PQRS Measure

 Report via: Registry, Measure Group
 This measure is can be reported as part of the following groups:
 Coronary Artery Disease (CAD) Group   

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.
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.
4086FAspirin or clopidogrel prescribed or currently being taken (CAD)
4086F8PAspirin or clopidogrel prescribed or currently being taken (CAD)
4086F1PAspirin or clopidogrel prescribed or currently being taken (CAD)
4086F2PAspirin or clopidogrel prescribed or currently being taken (CAD)
4086F3PAspirin or clopidogrel prescribed or currently being taken (CAD)

ICD9 Codes

CodeModifierPOSDescription
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
412Old myocardial infarction
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
414.2Chronic total occlusion of coronary artery
414.3Coronary atherosclerosis due to lipid rich plaque
414.8Other specified forms of chronic ischemic heart disease
414.9Chronic ischemic heart disease, unspecified
V45.81Aortocoronary bypass status
V45.82Percutaneous transluminal coronary angioplasty status

ICD10CM Codes

CodeModifierPOSDescription
I20.0Unstable angina
I20.1Angina pectoris with documented spasm
I20.8Other forms of angina pectoris
I20.9Angina pectoris, unspecified
I21.01ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29ST elevation (STEMI) myocardial infarction involving other sites
I21.3ST elevation (STEMI) myocardial infarction of unspecified site
I21.4Non-ST elevation (NSTEMI) myocardial infarction
I22.0Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.1Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
I22.2Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I24.0Acute coronary thrombosis not resulting in myocardial infarction
I24.1Dressler's syndrome
I24.8Other forms of acute ischemic heart disease
I24.9Acute ischemic heart disease, unspecified
I25.10Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.2Old myocardial infarction
I25.5Ischemic cardiomyopathy
I25.6Silent myocardial ischemia
I25.700Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.701Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.708Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.709Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
I25.710Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
I25.720Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
I25.730Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I25.810Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.82Chronic total occlusion of coronary artery
I25.83Coronary atherosclerosis due to lipid rich plaque
I25.89Other forms of chronic ischemic heart disease
I25.9Chronic ischemic heart disease, unspecified
Z95.1Presence of aortocoronary bypass graft
Z95.5Presence of coronary angioplasty implant and graft
Z98.61Coronary angioplasty status
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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