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

PQRS Measure

 Report via: Registry, Measure Group
 This measure is can be reported as part of the following groups:
 Diabetes Mellitus Group   

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
11042Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
11043Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
11044Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less
11055Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
11056Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions
11057Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than 4 lesions
11719Trimming of nondystrophic nails, any number
11720Debridement of nail(s) by any method(s); 1 to 5
11721Debridement of nail(s) by any method(s); 6 or more
11730Avulsion of nail plate, partial or complete, simple; single
11740Evacuation of subungual hematoma
97001Physical therapy evaluation
97002Physical therapy re-evaluation
97597Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less
97598Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
97802Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97803Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
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.
99304Initial 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.
99305Initial 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.
99306Initial 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.
99307Subsequent 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.
99308Subsequent 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.
99309Subsequent 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.
99310Subsequent 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.
99324Domiciliary 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.
99325Domiciliary 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.
99326Domiciliary 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.
99327Domiciliary 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.
99328Domiciliary 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.
99334Domiciliary 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.
99335Domiciliary 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.
99336Domiciliary 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.
99337Domiciliary 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.
99341Home 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.
99342Home 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.
99343Home 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.
99344Home 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.
99345Home 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.
99347Home 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.
99348Home 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.
99349Home 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.
99350Home 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.

HCPCS Codes

CodeModifierPOSDescription
G8404Lower extremity neurological exam performed and documented
G8405Lower extremity neurological exam not performed

ICD10CM Codes

CodeModifierPOSDescription
E10.10Type 1 diabetes mellitus with ketoacidosis without coma
E10.11Type 1 diabetes mellitus with ketoacidosis with coma
E10.21Type 1 diabetes mellitus with diabetic nephropathy
E10.22Type 1 diabetes mellitus with diabetic chronic kidney disease
E10.29Type 1 diabetes mellitus with other diabetic kidney complication
E10.311Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E10.319Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E10.321Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E10.329Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E10.331Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E10.339Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E10.341Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E10.349Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E10.351Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema
E10.359Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema
E10.36Type 1 diabetes mellitus with diabetic cataract
E10.39Type 1 diabetes mellitus with other diabetic ophthalmic complication
E10.40Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E10.41Type 1 diabetes mellitus with diabetic mononeuropathy
E10.42Type 1 diabetes mellitus with diabetic polyneuropathy
E10.43Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
E10.44Type 1 diabetes mellitus with diabetic amyotrophy
E10.49Type 1 diabetes mellitus with other diabetic neurological complication
E10.51Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E10.52Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.59Type 1 diabetes mellitus with other circulatory complications
E10.610Type 1 diabetes mellitus with diabetic neuropathic arthropathy
E10.618Type 1 diabetes mellitus with other diabetic arthropathy
E10.620Type 1 diabetes mellitus with diabetic dermatitis
E10.621Type 1 diabetes mellitus with foot ulcer
E10.622Type 1 diabetes mellitus with other skin ulcer
E10.628Type 1 diabetes mellitus with other skin complications
E10.630Type 1 diabetes mellitus with periodontal disease
E10.638Type 1 diabetes mellitus with other oral complications
E10.641Type 1 diabetes mellitus with hypoglycemia with coma
E10.649Type 1 diabetes mellitus with hypoglycemia without coma
E10.65Type 1 diabetes mellitus with hyperglycemia
E10.69Type 1 diabetes mellitus with other specified complication
E10.8Type 1 diabetes mellitus with unspecified complications
E10.9Type 1 diabetes mellitus without complications
E11.00Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E11.01Type 2 diabetes mellitus with hyperosmolarity with coma
E11.21Type 2 diabetes mellitus with diabetic nephropathy
E11.22Type 2 diabetes mellitus with diabetic chronic kidney disease
E11.29Type 2 diabetes mellitus with other diabetic kidney complication
E11.311Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E11.319Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E11.321Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E11.329Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E11.331Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E11.339Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E11.341Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E11.349Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E11.351Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema
E11.359Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema
E11.36Type 2 diabetes mellitus with diabetic cataract
E11.39Type 2 diabetes mellitus with other diabetic ophthalmic complication
E11.40Type 2 diabetes mellitus with diabetic neuropathy, unspecified
E11.41Type 2 diabetes mellitus with diabetic mononeuropathy
E11.42Type 2 diabetes mellitus with diabetic polyneuropathy
E11.43Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E11.44Type 2 diabetes mellitus with diabetic amyotrophy
E11.49Type 2 diabetes mellitus with other diabetic neurological complication
E11.51Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E11.52Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.59Type 2 diabetes mellitus with other circulatory complications
E11.610Type 2 diabetes mellitus with diabetic neuropathic arthropathy
E11.618Type 2 diabetes mellitus with other diabetic arthropathy
E11.620Type 2 diabetes mellitus with diabetic dermatitis
E11.621Type 2 diabetes mellitus with foot ulcer
E11.622Type 2 diabetes mellitus with other skin ulcer
E11.628Type 2 diabetes mellitus with other skin complications
E11.630Type 2 diabetes mellitus with periodontal disease
E11.638Type 2 diabetes mellitus with other oral complications
E11.641Type 2 diabetes mellitus with hypoglycemia with coma
E11.649Type 2 diabetes mellitus with hypoglycemia without coma
E11.65Type 2 diabetes mellitus with hyperglycemia
E11.69Type 2 diabetes mellitus with other specified complication
E11.8Type 2 diabetes mellitus with unspecified complications
E11.9Type 2 diabetes mellitus without complications
E13.00Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E13.01Other specified diabetes mellitus with hyperosmolarity with coma
E13.10Other specified diabetes mellitus with ketoacidosis without coma
E13.11Other specified diabetes mellitus with ketoacidosis with coma
E13.21Other specified diabetes mellitus with diabetic nephropathy
E13.22Other specified diabetes mellitus with diabetic chronic kidney disease
E13.29Other specified diabetes mellitus with other diabetic kidney complication
E13.311Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema
E13.319Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema
E13.321Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E13.329Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E13.331Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E13.339Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E13.341Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E13.349Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
E13.351Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema
E13.359Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema
E13.36Other specified diabetes mellitus with diabetic cataract
E13.39Other specified diabetes mellitus with other diabetic ophthalmic complication
E13.40Other specified diabetes mellitus with diabetic neuropathy, unspecified
E13.41Other specified diabetes mellitus with diabetic mononeuropathy
E13.42Other specified diabetes mellitus with diabetic polyneuropathy
E13.43Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
E13.44Other specified diabetes mellitus with diabetic amyotrophy
E13.49Other specified diabetes mellitus with other diabetic neurological complication
E13.51Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene
E13.52Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
E13.59Other specified diabetes mellitus with other circulatory complications
E13.610Other specified diabetes mellitus with diabetic neuropathic arthropathy
E13.618Other specified diabetes mellitus with other diabetic arthropathy
E13.620Other specified diabetes mellitus with diabetic dermatitis
E13.621Other specified diabetes mellitus with foot ulcer
E13.622Other specified diabetes mellitus with other skin ulcer
E13.628Other specified diabetes mellitus with other skin complications
E13.630Other specified diabetes mellitus with periodontal disease
E13.638Other specified diabetes mellitus with other oral complications
E13.641Other specified diabetes mellitus with hypoglycemia with coma
E13.649Other specified diabetes mellitus with hypoglycemia without coma
E13.65Other specified diabetes mellitus with hyperglycemia
E13.69Other specified diabetes mellitus with other specified complication
E13.8Other specified diabetes mellitus with unspecified complications
E13.9Other specified diabetes mellitus without complications
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.
demo
request yours today
subscribe
start today
newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.