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PQRS Measure

 Report via: Claim, Registry

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.
99281N/AN/AEmergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
99282N/AN/AEmergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
99283N/AN/AEmergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making
99284N/AN/AEmergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
99285N/AN/AEmergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making
4130FN/AN/ATopical preparations (including OTC) prescribed for acute otitis externa (AOE)
4130F8PN/ATopical preparations (including OTC) prescribed for acute otitis externa (AOE)
4130F1PN/ATopical preparations (including OTC) prescribed for acute otitis externa (AOE)
4130F2PN/ATopical preparations (including OTC) prescribed for acute otitis externa (AOE)

ICD9 Codes

CodeModifierPOSDescription
380.10N/AN/AInfective otitis externa, unspecified
380.11N/AN/AAcute infection of pinna
380.12N/AN/AAcute swimmers' ear
380.13N/AN/AOther acute infections of external ear
380.22N/AN/AOther acute otitis externa

ICD10CM Codes

CodeModifierPOSDescription
H60.00N/AN/AAbscess of external ear, unspecified ear
H60.01N/AN/AAbscess of right external ear
H60.02N/AN/AAbscess of left external ear
H60.03N/AN/AAbscess of external ear, bilateral
H60.10N/AN/ACellulitis of external ear, unspecified ear
H60.11N/AN/ACellulitis of right external ear
H60.12N/AN/ACellulitis of left external ear
H60.13N/AN/ACellulitis of external ear, bilateral
H60.311N/AN/ADiffuse otitis externa, right ear
H60.312N/AN/ADiffuse otitis externa, left ear
H60.313N/AN/ADiffuse otitis externa, bilateral
H60.319N/AN/ADiffuse otitis externa, unspecified ear
H60.321N/AN/AHemorrhagic otitis externa, right ear
H60.322N/AN/AHemorrhagic otitis externa, left ear
H60.323N/AN/AHemorrhagic otitis externa, bilateral
H60.329N/AN/AHemorrhagic otitis externa, unspecified ear
H60.331N/AN/ASwimmer's ear, right ear
H60.332N/AN/ASwimmer's ear, left ear
H60.333N/AN/ASwimmer's ear, bilateral
H60.339N/AN/ASwimmer's ear, unspecified ear
H60.391N/AN/AOther infective otitis externa, right ear
H60.392N/AN/AOther infective otitis externa, left ear
H60.393N/AN/AOther infective otitis externa, bilateral
H60.399N/AN/AOther infective otitis externa, unspecified ear
H60.501N/AN/AUnspecified acute noninfective otitis externa, right ear
H60.502N/AN/AUnspecified acute noninfective otitis externa, left ear
H60.503N/AN/AUnspecified acute noninfective otitis externa, bilateral
H60.509N/AN/AUnspecified acute noninfective otitis externa, unspecified ear
H60.511N/AN/AAcute actinic otitis externa, right ear
H60.512N/AN/AAcute actinic otitis externa, left ear
H60.513N/AN/AAcute actinic otitis externa, bilateral
H60.519N/AN/AAcute actinic otitis externa, unspecified ear
H60.521N/AN/AAcute chemical otitis externa, right ear
H60.522N/AN/AAcute chemical otitis externa, left ear
H60.523N/AN/AAcute chemical otitis externa, bilateral
H60.529N/AN/AAcute chemical otitis externa, unspecified ear
H60.531N/AN/AAcute contact otitis externa, right ear
H60.532N/AN/AAcute contact otitis externa, left ear
H60.533N/AN/AAcute contact otitis externa, bilateral
H60.539N/AN/AAcute contact otitis externa, unspecified ear
H60.541N/AN/AAcute eczematoid otitis externa, right ear
H60.542N/AN/AAcute eczematoid otitis externa, left ear
H60.543N/AN/AAcute eczematoid otitis externa, bilateral
H60.549N/AN/AAcute eczematoid otitis externa, unspecified ear
H60.551N/AN/AAcute reactive otitis externa, right ear
H60.552N/AN/AAcute reactive otitis externa, left ear
H60.553N/AN/AAcute reactive otitis externa, bilateral
H60.559N/AN/AAcute reactive otitis externa, unspecified ear
H60.591N/AN/AOther noninfective acute otitis externa, right ear
H60.592N/AN/AOther noninfective acute otitis externa, left ear
H60.593N/AN/AOther noninfective acute otitis externa, bilateral
H60.599N/AN/AOther noninfective acute otitis externa, unspecified ear
H61.90N/AN/ADisorder of external ear, unspecified, unspecified ear
H61.91N/AN/ADisorder of right external ear, unspecified
H61.92N/AN/ADisorder of left external ear, unspecified
H61.93N/AN/ADisorder of external ear, unspecified, bilateral
H62.40N/AN/AOtitis externa in other diseases classified elsewhere, unspecified ear
H62.41N/AN/AOtitis externa in other diseases classified elsewhere, right ear
H62.42N/AN/AOtitis externa in other diseases classified elsewhere, left ear
H62.43N/AN/AOtitis externa in other diseases classified elsewhere, bilateral
H62.8X1N/AN/AOther disorders of right external ear in diseases classified elsewhere
H62.8X2N/AN/AOther disorders of left external ear in diseases classified elsewhere
H62.8X3N/AN/AOther disorders of external ear in diseases classified elsewhere, bilateral
H62.8X9N/AN/AOther disorders of external ear in diseases classified elsewhere, unspecified ear
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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