PQRS Measure
Report via: Registry, EHR, Measure Group
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 99201 | Office 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. | ||
| 99202 | Office 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. | ||
| 99203 | Office 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. | ||
| 99204 | Office 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. | ||
| 99205 | Office 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. | ||
| 99212 | Office 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. | ||
| 99213 | Office 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. | ||
| 99214 | Office 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. | ||
| 99215 | Office 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. | ||
| 99341 | Home 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. | ||
| 99342 | Home 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. | ||
| 99343 | 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 face-to-face with the patient and/or family. | ||
| 99344 | Home 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. | ||
| 99345 | Home 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. | ||
| 99347 | Home 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. | ||
| 99348 | Home 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. | ||
| 99349 | Home 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. | ||
| 99350 | Home 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. | ||
| 3060F | Positive microalbuminuria test result documented and reviewed (DM) | ||
| 3060F | 8P | Positive microalbuminuria test result documented and reviewed (DM) | |
| 3061F | Negative microalbuminuria test result documented and reviewed (DM) | ||
| 3061F | 8P | Negative microalbuminuria test result documented and reviewed (DM) | |
| 3062F | Positive macroalbuminuria test result documented and reviewed (DM) | ||
| 3062F | 8P | Positive macroalbuminuria test result documented and reviewed (DM) | |
| 3066F | Documentation of treatment for nephropathy (eg, patient receiving dialysis, patient being treated for ESRD, CRF, ARF, or renal insufficiency, any visit to a nephrologist) (DM) | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | ||
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | ||
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | ||
| G8506 | Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy | ||
| E08.22 | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease | ||
| E08.29 | Diabetes mellitus due to underlying condition with other diabetic kidney complication | ||
| E09.21 | Drug or chemical induced diabetes mellitus with diabetic nephropathy | ||
| E09.22 | Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease | ||
| E09.29 | Drug or chemical induced diabetes mellitus with other diabetic kidney complication | ||
| E10.10 | Type 1 diabetes mellitus with ketoacidosis without coma | ||
| E10.11 | Type 1 diabetes mellitus with ketoacidosis with coma | ||
| E10.21 | Type 1 diabetes mellitus with diabetic nephropathy | ||
| E10.22 | Type 1 diabetes mellitus with diabetic chronic kidney disease | ||
| E10.29 | Type 1 diabetes mellitus with other diabetic kidney complication | ||
| E10.311 | Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema | ||
| E10.319 | Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema | ||
| E10.321 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema | ||
| E10.329 | Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema | ||
| E10.331 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema | ||
| E10.339 | Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema | ||
| E10.341 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema | ||
| E10.349 | Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema | ||
| E10.351 | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema | ||
| E10.359 | Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema | ||
| E10.36 | Type 1 diabetes mellitus with diabetic cataract | ||
| E10.39 | Type 1 diabetes mellitus with other diabetic ophthalmic complication | ||
| E10.40 | Type 1 diabetes mellitus with diabetic neuropathy, unspecified | ||
| E10.41 | Type 1 diabetes mellitus with diabetic mononeuropathy | ||
| E10.42 | Type 1 diabetes mellitus with diabetic polyneuropathy | ||
| E10.43 | Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy | ||
| E10.44 | Type 1 diabetes mellitus with diabetic amyotrophy | ||
| E10.49 | Type 1 diabetes mellitus with other diabetic neurological complication | ||
| E10.51 | Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene | ||
| E10.52 | Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene | ||
| E10.59 | Type 1 diabetes mellitus with other circulatory complications | ||
| E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy | ||
| E10.618 | Type 1 diabetes mellitus with other diabetic arthropathy | ||
| E10.620 | Type 1 diabetes mellitus with diabetic dermatitis | ||
| E10.621 | Type 1 diabetes mellitus with foot ulcer | ||
| E10.622 | Type 1 diabetes mellitus with other skin ulcer | ||
| E10.628 | Type 1 diabetes mellitus with other skin complications | ||
| E10.630 | Type 1 diabetes mellitus with periodontal disease | ||
| E10.638 | Type 1 diabetes mellitus with other oral complications | ||
| E10.641 | Type 1 diabetes mellitus with hypoglycemia with coma | ||
| E10.649 | Type 1 diabetes mellitus with hypoglycemia without coma | ||
| E10.65 | Type 1 diabetes mellitus with hyperglycemia | ||
| E10.69 | Type 1 diabetes mellitus with other specified complication | ||
| E10.8 | Type 1 diabetes mellitus with unspecified complications | ||
| E10.9 | Type 1 diabetes mellitus without complications | ||
| E11.00 | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | ||
| E11.01 | Type 2 diabetes mellitus with hyperosmolarity with coma | ||
| E11.21 | Type 2 diabetes mellitus with diabetic nephropathy | ||
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease | ||
| E11.29 | Type 2 diabetes mellitus with other diabetic kidney complication | ||
| E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema | ||
| E11.319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema | ||
| E11.321 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema | ||
| E11.329 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema | ||
| E11.331 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema | ||
| E11.339 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema | ||
| E11.341 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema | ||
| E11.349 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema | ||
| E11.351 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema | ||
| E11.359 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema | ||
| E11.36 | Type 2 diabetes mellitus with diabetic cataract | ||
| E11.39 | Type 2 diabetes mellitus with other diabetic ophthalmic complication | ||
| E11.40 | Type 2 diabetes mellitus with diabetic neuropathy, unspecified | ||
| E11.41 | Type 2 diabetes mellitus with diabetic mononeuropathy | ||
| E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy | ||
| E11.43 | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy | ||
| E11.44 | Type 2 diabetes mellitus with diabetic amyotrophy | ||
| E11.49 | Type 2 diabetes mellitus with other diabetic neurological complication | ||
| E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene | ||
| E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene | ||
| E11.59 | Type 2 diabetes mellitus with other circulatory complications | ||
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy | ||
| E11.618 | Type 2 diabetes mellitus with other diabetic arthropathy | ||
| E11.620 | Type 2 diabetes mellitus with diabetic dermatitis | ||
| E11.621 | Type 2 diabetes mellitus with foot ulcer | ||
| E11.622 | Type 2 diabetes mellitus with other skin ulcer | ||
| E11.628 | Type 2 diabetes mellitus with other skin complications | ||
| E11.630 | Type 2 diabetes mellitus with periodontal disease | ||
| E11.638 | Type 2 diabetes mellitus with other oral complications | ||
| E11.641 | Type 2 diabetes mellitus with hypoglycemia with coma | ||
| E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma | ||
| E11.65 | Type 2 diabetes mellitus with hyperglycemia | ||
| E11.69 | Type 2 diabetes mellitus with other specified complication | ||
| E11.8 | Type 2 diabetes mellitus with unspecified complications | ||
| E11.9 | Type 2 diabetes mellitus without complications | ||
| E13.00 | Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | ||
| E13.01 | Other specified diabetes mellitus with hyperosmolarity with coma | ||
| E13.10 | Other specified diabetes mellitus with ketoacidosis without coma | ||
| E13.11 | Other specified diabetes mellitus with ketoacidosis with coma | ||
| E13.21 | Other specified diabetes mellitus with diabetic nephropathy | ||
| E13.22 | Other specified diabetes mellitus with diabetic chronic kidney disease | ||
| E13.29 | Other specified diabetes mellitus with other diabetic kidney complication | ||
| E13.311 | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema | ||
| E13.319 | Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema | ||
| E13.321 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema | ||
| E13.329 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema | ||
| E13.331 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema | ||
| E13.339 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema | ||
| E13.341 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema | ||
| E13.349 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema | ||
| E13.351 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema | ||
| E13.359 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema | ||
| E13.36 | Other specified diabetes mellitus with diabetic cataract | ||
| E13.39 | Other specified diabetes mellitus with other diabetic ophthalmic complication | ||
| E13.40 | Other specified diabetes mellitus with diabetic neuropathy, unspecified | ||
| E13.41 | Other specified diabetes mellitus with diabetic mononeuropathy | ||
| E13.42 | Other specified diabetes mellitus with diabetic polyneuropathy | ||
| E13.43 | Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy | ||
| E13.44 | Other specified diabetes mellitus with diabetic amyotrophy | ||
| E13.49 | Other specified diabetes mellitus with other diabetic neurological complication | ||
| E13.51 | Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene | ||
| E13.52 | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene | ||
| E13.59 | Other specified diabetes mellitus with other circulatory complications | ||
| E13.610 | Other specified diabetes mellitus with diabetic neuropathic arthropathy | ||
| E13.618 | Other specified diabetes mellitus with other diabetic arthropathy | ||
| E13.620 | Other specified diabetes mellitus with diabetic dermatitis | ||
| E13.621 | Other specified diabetes mellitus with foot ulcer | ||
| E13.622 | Other specified diabetes mellitus with other skin ulcer | ||
| E13.628 | Other specified diabetes mellitus with other skin complications | ||
| E13.630 | Other specified diabetes mellitus with periodontal disease | ||
| E13.638 | Other specified diabetes mellitus with other oral complications | ||
| E13.641 | Other specified diabetes mellitus with hypoglycemia with coma | ||
| E13.649 | Other specified diabetes mellitus with hypoglycemia without coma | ||
| E13.65 | Other specified diabetes mellitus with hyperglycemia | ||
| E13.69 | Other specified diabetes mellitus with other specified complication | ||
| E13.8 | Other specified diabetes mellitus with unspecified complications | ||
| E13.9 | Other specified diabetes mellitus without complications | ||
| O24.011 | Pre-existing type 1 diabetes mellitus, in pregnancy, first trimester | ||
| O24.012 | Pre-existing type 1 diabetes mellitus, in pregnancy, second trimester | ||
| O24.013 | Pre-existing type 1 diabetes mellitus, in pregnancy, third trimester | ||
| O24.019 | Pre-existing type 1 diabetes mellitus, in pregnancy, unspecified trimester | ||
| O24.02 | Pre-existing type 1 diabetes mellitus, in childbirth | ||
| O24.03 | Pre-existing type 1 diabetes mellitus, in the puerperium | ||
| O24.111 | Pre-existing type 2 diabetes mellitus, in pregnancy, first trimester | ||
| O24.112 | Pre-existing type 2 diabetes mellitus, in pregnancy, second trimester | ||
| O24.113 | Pre-existing type 2 diabetes mellitus, in pregnancy, third trimester | ||
| O24.119 | Pre-existing type 2 diabetes mellitus, in pregnancy, unspecified trimester | ||
| O24.12 | Pre-existing type 2 diabetes mellitus, in childbirth | ||
| O24.13 | Pre-existing type 2 diabetes mellitus, in the puerperium | ||
| O24.311 | Unspecified pre-existing diabetes mellitus in pregnancy, first trimester | ||
| O24.312 | Unspecified pre-existing diabetes mellitus in pregnancy, second trimester | ||
| O24.313 | Unspecified pre-existing diabetes mellitus in pregnancy, third trimester | ||
| O24.319 | Unspecified pre-existing diabetes mellitus in pregnancy, unspecified trimester | ||
| O24.32 | Unspecified pre-existing diabetes mellitus in childbirth | ||
| O24.33 | Unspecified pre-existing diabetes mellitus in the puerperium | ||
| O24.811 | Other pre-existing diabetes mellitus in pregnancy, first trimester | ||
| O24.812 | Other pre-existing diabetes mellitus in pregnancy, second trimester | ||
| O24.813 | Other pre-existing diabetes mellitus in pregnancy, third trimester | ||
| O24.819 | Other pre-existing diabetes mellitus in pregnancy, unspecified trimester | ||
| O24.82 | Other pre-existing diabetes mellitus in childbirth | ||
| O24.83 | Other pre-existing diabetes mellitus in the puerperium | ||
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.
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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