PQRS Measure
This measure may be submitted via Registry only
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 99218 | Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or 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 problem(s) requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99219 | Initial observation care, per day, for the evaluation and management of a 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 problem(s) requiring admission to outpatient hospital "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99220 | Initial observation care, per day, for the evaluation and management of a 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 problem(s) requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99221 | Initial hospital inpatient or observation 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 medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | ||
| 99222 | Initial hospital inpatient or observation 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, 55 minutes must be met or exceeded. | ||
| 99223 | Initial hospital inpatient or observation 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, 75 minutes must be met or exceeded. | ||
| 99224 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or 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 patient is stable, recovering, or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99225 | Subsequent observation care, per day, for the evaluation and management of a 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 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 patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99226 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; 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 complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit. | ||
| 99231 | Subsequent hospital inpatient or observation 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. | ||
| 99232 | Subsequent hospital inpatient or observation 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. | ||
| 99233 | Subsequent hospital inpatient or observation 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. | ||
| 99281 | Emergency 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 | ||
| 99282 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making | ||
| 99283 | Emergency 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 | ||
| 99284 | Emergency 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 | ||
| 99285 | Emergency 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 | ||
| 99291 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G8600 | Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well | ||
| G8601 | Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention) | ||
| G8602 | Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| I63.00 | Cerebral infarction due to thrombosis of unspecified precerebral artery | ||
| I63.011 | Cerebral infarction due to thrombosis of right vertebral artery | ||
| I63.012 | Cerebral infarction due to thrombosis of left vertebral artery | ||
| I63.019 | Cerebral infarction due to thrombosis of unspecified vertebral artery | ||
| I63.02 | Cerebral infarction due to thrombosis of basilar artery | ||
| I63.031 | Cerebral infarction due to thrombosis of right carotid artery | ||
| I63.032 | Cerebral infarction due to thrombosis of left carotid artery | ||
| I63.039 | Cerebral infarction due to thrombosis of unspecified carotid artery | ||
| I63.09 | Cerebral infarction due to thrombosis of other precerebral artery | ||
| I63.10 | Cerebral infarction due to embolism of unspecified precerebral artery | ||
| I63.111 | Cerebral infarction due to embolism of right vertebral artery | ||
| I63.112 | Cerebral infarction due to embolism of left vertebral artery | ||
| I63.119 | Cerebral infarction due to embolism of unspecified vertebral artery | ||
| I63.12 | Cerebral infarction due to embolism of basilar artery | ||
| I63.131 | Cerebral infarction due to embolism of right carotid artery | ||
| I63.132 | Cerebral infarction due to embolism of left carotid artery | ||
| I63.139 | Cerebral infarction due to embolism of unspecified carotid artery | ||
| I63.19 | Cerebral infarction due to embolism of other precerebral artery | ||
| I63.20 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries | ||
| I63.211 | Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery | ||
| I63.212 | Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery | ||
| I63.219 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery | ||
| I63.22 | Cerebral infarction due to unspecified occlusion or stenosis of basilar artery | ||
| I63.231 | Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries | ||
| I63.232 | Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries | ||
| I63.239 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery | ||
| I63.29 | Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries | ||
| I63.30 | Cerebral infarction due to thrombosis of unspecified cerebral artery | ||
| I63.311 | Cerebral infarction due to thrombosis of right middle cerebral artery | ||
| I63.312 | Cerebral infarction due to thrombosis of left middle cerebral artery | ||
| I63.319 | Cerebral infarction due to thrombosis of unspecified middle cerebral artery | ||
| I63.321 | Cerebral infarction due to thrombosis of right anterior cerebral artery | ||
| I63.322 | Cerebral infarction due to thrombosis of left anterior cerebral artery | ||
| I63.329 | Cerebral infarction due to thrombosis of unspecified anterior cerebral artery | ||
| I63.331 | Cerebral infarction due to thrombosis of right posterior cerebral artery | ||
| I63.332 | Cerebral infarction due to thrombosis of left posterior cerebral artery | ||
| I63.339 | Cerebral infarction due to thrombosis of unspecified posterior cerebral artery | ||
| I63.341 | Cerebral infarction due to thrombosis of right cerebellar artery | ||
| I63.342 | Cerebral infarction due to thrombosis of left cerebellar artery | ||
| I63.349 | Cerebral infarction due to thrombosis of unspecified cerebellar artery | ||
| I63.39 | Cerebral infarction due to thrombosis of other cerebral artery | ||
| I63.40 | Cerebral infarction due to embolism of unspecified cerebral artery | ||
| I63.411 | Cerebral infarction due to embolism of right middle cerebral artery | ||
| I63.412 | Cerebral infarction due to embolism of left middle cerebral artery | ||
| I63.419 | Cerebral infarction due to embolism of unspecified middle cerebral artery | ||
| I63.421 | Cerebral infarction due to embolism of right anterior cerebral artery | ||
| I63.422 | Cerebral infarction due to embolism of left anterior cerebral artery | ||
| I63.429 | Cerebral infarction due to embolism of unspecified anterior cerebral artery | ||
| I63.431 | Cerebral infarction due to embolism of right posterior cerebral artery | ||
| I63.432 | Cerebral infarction due to embolism of left posterior cerebral artery | ||
| I63.439 | Cerebral infarction due to embolism of unspecified posterior cerebral artery | ||
| I63.441 | Cerebral infarction due to embolism of right cerebellar artery | ||
| I63.442 | Cerebral infarction due to embolism of left cerebellar artery | ||
| I63.449 | Cerebral infarction due to embolism of unspecified cerebellar artery | ||
| I63.50 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery | ||
| I63.511 | Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery | ||
| I63.512 | Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery | ||
| I63.519 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery | ||
| I63.521 | Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery | ||
| I63.522 | Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery | ||
| I63.529 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery | ||
| I63.531 | Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery | ||
| I63.532 | Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery | ||
| I63.539 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery | ||
| I63.541 | Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery | ||
| I63.542 | Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery | ||
| I63.549 | Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery | ||
| I63.59 | Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery | ||
| I63.6 | Cerebral infarction due to cerebral venous thrombosis, nonpyogenic | ||
| I63.8 | Other cerebral infarction | ||
| I63.9 | Cerebral infarction, unspecified | ||
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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