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PQRS Measure

#71Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
 Description  Data Collection Sheet  Coding Specifications Registry OK.

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.
3315FEstrogen receptor (ER) or progesterone receptor (PR) positive breast cancer (ONC)
3316FEstrogen receptor (ER) and progesterone receptor (PR) negative breast cancer (ONC)
3316F8PEstrogen receptor (ER) and progesterone receptor (PR) negative breast cancer (ONC)
3370FAJCC Breast Cancer Stage 0 documented (ONC)
3370F8PAJCC Breast Cancer Stage 0 documented (ONC)
3372FAJCC Breast Cancer Stage I: T1mic, T1a or T1b (tumor size <= 1 cm) documented (ONC)
3374FAJCC Breast Cancer Stage I: T1c (tumor size > 1 cm to 2 cm) documented (ONC)
3376FAJCC Breast Cancer Stage II documented (ONC)
3378FAJCC Breast Cancer Stage III documented (ONC)
3380FAJCC Breast Cancer Stage IV documented (ONC)
4179FTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179F1PTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179F2PTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179F3PTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179F8PTamoxifen or aromatase inhibitor (AI) prescribed (ONC)

ICD9 Codes

CodeModifierPOSDescription
174
174.1Malignant neoplasm of central portion of female breast
174.2Malignant neoplasm of upper-inner quadrant of female breast
174.3Malignant neoplasm of lower-inner quadrant of female breast
174.4Malignant neoplasm of upper-outer quadrant of female breast
174.5Malignant neoplasm of lower-outer quadrant of female breast
174.6Malignant neoplasm of axillary tail of female breast
174.8Malignant neoplasm of other specified sites of female breast
174.9Malignant neoplasm of breast (female), unspecified
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.
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