Year:  2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 

PQRS Measure

 Report via: Registry, GPRO/ACO, 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
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.
99304N/AN/AInitial 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.
99305N/AN/AInitial 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.
99306N/AN/AInitial 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.
99307N/AN/ASubsequent 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.
99308N/AN/ASubsequent 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.
99309N/AN/ASubsequent 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.
99310N/AN/ASubsequent 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.
99324N/AN/ADomiciliary 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.
99325N/AN/ADomiciliary 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.
99326N/AN/ADomiciliary 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.
99327N/AN/ADomiciliary 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.
99328N/AN/ADomiciliary 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.
99334N/AN/ADomiciliary 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.
99335N/AN/ADomiciliary 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.
99336N/AN/ADomiciliary 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.
99337N/AN/ADomiciliary 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.
99341N/AN/AHome 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.
99342N/AN/AHome 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.
99343N/AN/AHome 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.
99344N/AN/AHome 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.
99345N/AN/AHome 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.
99347N/AN/AHome 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.
99348N/AN/AHome 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.
99349N/AN/AHome 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.
99350N/AN/AHome 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.
4013FN/AN/AStatin therapy prescribed or currently being taken (CAD)
0556FN/AN/APlan of care to achieve lipid control documented (CAD)
0556FN/AN/APlan of care to achieve lipid control documented (CAD)
4013F1PN/AStatin therapy prescribed or currently being taken (CAD)
4013F2PN/AStatin therapy prescribed or currently being taken (CAD)
4013F3PN/AStatin therapy prescribed or currently being taken (CAD)
4013F8PN/AStatin therapy prescribed or currently being taken (CAD)
0556F8PN/APlan of care to achieve lipid control documented (CAD)

HCPCS Codes

CodeModifierPOSDescription
G8736N/AN/AMost current ldl-c <100mg/dl
G8737N/AN/AMost current ldl-c >=100mg/dl
G8737N/AN/AMost current ldl-c >=100mg/dl
G8737N/AN/AMost current ldl-c >=100mg/dl
G8737N/AN/AMost current ldl-c >=100mg/dl
G8943N/AN/ALdl-c result not present or not within 12 months prior

ICD9 Codes

CodeModifierPOSDescription
410.00N/AN/AAcute myocardial infarction of anterolateral wall, episode of care unspecified
410.01N/AN/AAcute myocardial infarction of anterolateral wall, initial episode of care
410.02N/AN/AAcute myocardial infarction of anterolateral wall, subsequent episode of care
410.10N/AN/AAcute myocardial infarction of other anterior wall, episode of care unspecified
410.11N/AN/AAcute myocardial infarction of other anterior wall, initial episode of care
410.12N/AN/AAcute myocardial infarction of other anterior wall, subsequent episode of care
410.20N/AN/AAcute myocardial infarction of inferolateral wall, episode of care unspecified
410.21N/AN/AAcute myocardial infarction of inferolateral wall, initial episode of care
410.22N/AN/AAcute myocardial infarction of inferolateral wall, subsequent episode of care
410.30N/AN/AAcute myocardial infarction of inferoposterior wall, episode of care unspecified
410.31N/AN/AAcute myocardial infarction of inferoposterior wall, initial episode of care
410.32N/AN/AAcute myocardial infarction of inferoposterior wall, subsequent episode of care
410.40N/AN/AAcute myocardial infarction of other inferior wall, episode of care unspecified
410.41N/AN/AAcute myocardial infarction of other inferior wall, initial episode of care
410.42N/AN/AAcute myocardial infarction of other inferior wall, subsequent episode of care
410.50N/AN/AAcute myocardial infarction of other lateral wall, episode of care unspecified
410.51N/AN/AAcute myocardial infarction of other lateral wall, initial episode of care
410.52N/AN/AAcute myocardial infarction of other lateral wall, subsequent episode of care
410.60N/AN/ATrue posterior wall infarction, episode of care unspecified
410.61N/AN/ATrue posterior wall infarction, initial episode of care
410.62N/AN/ATrue posterior wall infarction, subsequent episode of care
410.70N/AN/ASubendocardial infarction, episode of care unspecified
410.71N/AN/ASubendocardial infarction, initial episode of care
410.72N/AN/ASubendocardial infarction, subsequent episode of care
410.80N/AN/AAcute myocardial infarction of other specified sites, episode of care unspecified
410.81N/AN/AAcute myocardial infarction of other specified sites, initial episode of care
410.82N/AN/AAcute myocardial infarction of other specified sites, subsequent episode of care
410.90N/AN/AAcute myocardial infarction of unspecified site, episode of care unspecified
410.91N/AN/AAcute myocardial infarction of unspecified site, initial episode of care
410.92N/AN/AAcute myocardial infarction of unspecified site, subsequent episode of care
411.0N/AN/APostmyocardial infarction syndrome
411.1N/AN/AIntermediate coronary syndrome
411.81N/AN/AAcute coronary occlusion without myocardial infarction
411.89N/AN/AOther acute and subacute forms of ischemic heart disease, other
412N/AN/AOld myocardial infarction
413.0N/AN/AAngina decubitus
413.1N/AN/APrinzmetal angina
413.9N/AN/AOther and unspecified angina pectoris
414.00N/AN/ACoronary atherosclerosis of unspecified type of vessel, native or graft
414.01N/AN/ACoronary atherosclerosis of native coronary artery
414.02N/AN/ACoronary atherosclerosis of autologous vein bypass graft
414.03N/AN/ACoronary atherosclerosis of nonautologous biological bypass graft
414.04N/AN/ACoronary atherosclerosis of artery bypass graft
414.05N/AN/ACoronary atherosclerosis of unspecified bypass graft
414.06N/AN/ACoronary atherosclerosis of native coronary artery of transplanted heart
414.07N/AN/ACoronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
414.2N/AN/AChronic total occlusion of coronary artery
414.3N/AN/ACoronary atherosclerosis due to lipid rich plaque
414.8N/AN/AOther specified forms of chronic ischemic heart disease
414.9N/AN/AChronic ischemic heart disease, unspecified
V45.81N/AN/AAortocoronary bypass status
V45.82N/AN/APercutaneous transluminal coronary angioplasty status

ICD10CM Codes

CodeModifierPOSDescription
I20.0N/AN/AUnstable angina
I20.1N/AN/AAngina pectoris with documented spasm
I20.8N/AN/AOther forms of angina pectoris
I20.9N/AN/AAngina pectoris, unspecified
I21.01N/AN/AST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02N/AN/AST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09N/AN/AST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11N/AN/AST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19N/AN/AST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21N/AN/AST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29N/AN/AST elevation (STEMI) myocardial infarction involving other sites
I21.3N/AN/AST elevation (STEMI) myocardial infarction of unspecified site
I21.4N/AN/ANon-ST elevation (NSTEMI) myocardial infarction
I22.0N/AN/ASubsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.1N/AN/ASubsequent ST elevation (STEMI) myocardial infarction of inferior wall
I22.2N/AN/ASubsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8N/AN/ASubsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9N/AN/ASubsequent ST elevation (STEMI) myocardial infarction of unspecified site
I24.0N/AN/AAcute coronary thrombosis not resulting in myocardial infarction
I24.1N/AN/ADressler's syndrome
I24.8N/AN/AOther forms of acute ischemic heart disease
I24.9N/AN/AAcute ischemic heart disease, unspecified
I25.10N/AN/AAtherosclerotic heart disease of native coronary artery without angina pectoris
I25.110N/AN/AAtherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111N/AN/AAtherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118N/AN/AAtherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119N/AN/AAtherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.2N/AN/AOld myocardial infarction
I25.5N/AN/AIschemic cardiomyopathy
I25.6N/AN/ASilent myocardial ischemia
I25.700N/AN/AAtherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.701N/AN/AAtherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.708N/AN/AAtherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.709N/AN/AAtherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
I25.710N/AN/AAtherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711N/AN/AAtherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718N/AN/AAtherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719N/AN/AAtherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
I25.720N/AN/AAtherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721N/AN/AAtherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728N/AN/AAtherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729N/AN/AAtherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
I25.730N/AN/AAtherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731N/AN/AAtherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738N/AN/AAtherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739N/AN/AAtherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750N/AN/AAtherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751N/AN/AAtherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758N/AN/AAtherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759N/AN/AAtherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760N/AN/AAtherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761N/AN/AAtherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768N/AN/AAtherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769N/AN/AAtherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790N/AN/AAtherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791N/AN/AAtherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798N/AN/AAtherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799N/AN/AAtherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I25.810N/AN/AAtherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811N/AN/AAtherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812N/AN/AAtherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.82N/AN/AChronic total occlusion of coronary artery
I25.83N/AN/ACoronary atherosclerosis due to lipid rich plaque
I25.89N/AN/AOther forms of chronic ischemic heart disease
I25.9N/AN/AChronic ischemic heart disease, unspecified
Z95.1N/AN/APresence of aortocoronary bypass graft
Z95.5N/AN/APresence of coronary angioplasty implant and graft
Z98.61N/AN/ACoronary 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).
GPRO/ACOThis 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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