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PQRS Measure

 Report via: Claim, Registry, EHR, Measure Group
 This measure is can be reported as part of the following groups:
 Oncology 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.
3315FEstrogen receptor (ER) or progesterone receptor (PR) positive breast cancer (ONC)
3315FEstrogen receptor (ER) or progesterone receptor (PR) positive breast cancer (ONC)
3315FEstrogen receptor (ER) or progesterone receptor (PR) positive breast cancer (ONC)
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)
3374FAJCC Breast Cancer Stage I: T1c (tumor size > 1 cm to 2 cm) documented (ONC)
3374FAJCC Breast Cancer Stage I: T1c (tumor size > 1 cm to 2 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)
3376FAJCC Breast Cancer Stage II documented (ONC)
3376FAJCC Breast Cancer Stage II documented (ONC)
3376FAJCC Breast Cancer Stage II documented (ONC)
3378FAJCC Breast Cancer Stage III documented (ONC)
3378FAJCC Breast Cancer Stage III documented (ONC)
3378FAJCC Breast Cancer Stage III documented (ONC)
3378FAJCC Breast Cancer Stage III documented (ONC)
3380FAJCC Breast Cancer Stage IV documented (ONC)
4179F1PTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179F2PTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179F3PTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179FTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179FTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179F8PTamoxifen or aromatase inhibitor (AI) prescribed (ONC)
4179F8PTamoxifen or aromatase inhibitor (AI) prescribed (ONC)

ICD9 Codes

CodeModifierPOSDescription
174.0Malignant neoplasm of nipple and areola of female breast
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

ICD10CM Codes

CodeModifierPOSDescription
C50.011Malignant neoplasm of nipple and areola, right female breast
C50.012Malignant neoplasm of nipple and areola, left female breast
C50.019Malignant neoplasm of nipple and areola, unspecified female breast
C50.111Malignant neoplasm of central portion of right female breast
C50.112Malignant neoplasm of central portion of left female breast
C50.119Malignant neoplasm of central portion of unspecified female breast
C50.211Malignant neoplasm of upper-inner quadrant of right female breast
C50.212Malignant neoplasm of upper-inner quadrant of left female breast
C50.219Malignant neoplasm of upper-inner quadrant of unspecified female breast
C50.311Malignant neoplasm of lower-inner quadrant of right female breast
C50.312Malignant neoplasm of lower-inner quadrant of left female breast
C50.319Malignant neoplasm of lower-inner quadrant of unspecified female breast
C50.411Malignant neoplasm of upper-outer quadrant of right female breast
C50.412Malignant neoplasm of upper-outer quadrant of left female breast
C50.419Malignant neoplasm of upper-outer quadrant of unspecified female breast
C50.511Malignant neoplasm of lower-outer quadrant of right female breast
C50.512Malignant neoplasm of lower-outer quadrant of left female breast
C50.519Malignant neoplasm of lower-outer quadrant of unspecified female breast
C50.611Malignant neoplasm of axillary tail of right female breast
C50.612Malignant neoplasm of axillary tail of left female breast
C50.619Malignant neoplasm of axillary tail of unspecified female breast
C50.811Malignant neoplasm of overlapping sites of right female breast
C50.812Malignant neoplasm of overlapping sites of left female breast
C50.819Malignant neoplasm of overlapping sites of unspecified female breast
C50.911Malignant neoplasm of unspecified site of right female breast
C50.912Malignant neoplasm of unspecified site of left female breast
C50.919Malignant neoplasm of unspecified site of unspecified female breast
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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