PQRS Measure
This measure may be submitted via Registry only
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 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. | ||
| 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. | ||
| 99238 | Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter | ||
| 99239 | Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | ||
| 99291 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | ||
| 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. | ||
| 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. | ||
| 99238 | Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter | ||
| 99239 | Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | ||
| 99291 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | ||
HCPCS Codes | |||
| Code | Modifier | POS | Description |
| G9402 | Patient received follow-up within 30 days after discharge | ||
| G9403 | Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up) | ||
| G9404 | Patient did not receive follow-up within 30 days after discharge | ||
| G9405 | Patient received follow-up within 7 days after discharge | ||
| G9406 | Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up) | ||
| G9407 | Patient did not receive follow-up within 7 days after discharge | ||
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| F20.0 | Paranoid schizophrenia | ||
| F20.1 | Disorganized schizophrenia | ||
| F20.2 | Catatonic schizophrenia | ||
| F20.3 | Undifferentiated schizophrenia | ||
| F20.5 | Residual schizophrenia | ||
| F20.81 | Schizophreniform disorder | ||
| F20.89 | Other schizophrenia | ||
| F20.9 | Schizophrenia, unspecified | ||
| F21 | Schizotypal disorder | ||
| F22 | Delusional disorders | ||
| F23 | Brief psychotic disorder | ||
| F24 | Shared psychotic disorder | ||
| F25.0 | Schizoaffective disorder, bipolar type | ||
| F25.1 | Schizoaffective disorder, depressive type | ||
| F25.8 | Other schizoaffective disorders | ||
| F25.9 | Schizoaffective disorder, unspecified | ||
| F28 | Other psychotic disorder not due to a substance or known physiological condition | ||
| F29 | Unspecified psychosis not due to a substance or known physiological condition | ||
| F30.10 | Manic episode without psychotic symptoms, unspecified | ||
| F30.11 | Manic episode without psychotic symptoms, mild | ||
| F30.12 | Manic episode without psychotic symptoms, moderate | ||
| F30.13 | Manic episode, severe, without psychotic symptoms | ||
| F30.2 | Manic episode, severe with psychotic symptoms | ||
| F30.3 | Manic episode in partial remission | ||
| F30.4 | Manic episode in full remission | ||
| F30.8 | Other manic episodes | ||
| F30.9 | Manic episode, unspecified | ||
| F31.0 | Bipolar disorder, current episode hypomanic | ||
| F31.10 | Bipolar disorder, current episode manic without psychotic features, unspecified | ||
| F31.11 | Bipolar disorder, current episode manic without psychotic features, mild | ||
| F31.12 | Bipolar disorder, current episode manic without psychotic features, moderate | ||
| F31.13 | Bipolar disorder, current episode manic without psychotic features, severe | ||
| F31.2 | Bipolar disorder, current episode manic severe with psychotic features | ||
| F31.30 | Bipolar disorder, current episode depressed, mild or moderate severity, unspecified | ||
| F31.31 | Bipolar disorder, current episode depressed, mild | ||
| F31.32 | Bipolar disorder, current episode depressed, moderate | ||
| F31.4 | Bipolar disorder, current episode depressed, severe, without psychotic features | ||
| F31.5 | Bipolar disorder, current episode depressed, severe, with psychotic features | ||
| F31.60 | Bipolar disorder, current episode mixed, unspecified | ||
| F31.61 | Bipolar disorder, current episode mixed, mild | ||
| F31.62 | Bipolar disorder, current episode mixed, moderate | ||
| F31.63 | Bipolar disorder, current episode mixed, severe, without psychotic features | ||
| F31.64 | Bipolar disorder, current episode mixed, severe, with psychotic features | ||
| F31.70 | Bipolar disorder, currently in remission, most recent episode unspecified | ||
| F31.71 | Bipolar disorder, in partial remission, most recent episode hypomanic | ||
| F31.72 | Bipolar disorder, in full remission, most recent episode hypomanic | ||
| F31.73 | Bipolar disorder, in partial remission, most recent episode manic | ||
| F31.74 | Bipolar disorder, in full remission, most recent episode manic | ||
| F31.75 | Bipolar disorder, in partial remission, most recent episode depressed | ||
| F31.76 | Bipolar disorder, in full remission, most recent episode depressed | ||
| F31.77 | Bipolar disorder, in partial remission, most recent episode mixed | ||
| F31.78 | Bipolar disorder, in full remission, most recent episode mixed | ||
| F31.81 | Bipolar II disorder | ||
| F31.89 | Other bipolar disorder | ||
| F31.9 | Bipolar disorder, unspecified | ||
| F32.0 | Major depressive disorder, single episode, mild | ||
| F32.1 | Major depressive disorder, single episode, moderate | ||
| F32.2 | Major depressive disorder, single episode, severe without psychotic features | ||
| F32.3 | Major depressive disorder, single episode, severe with psychotic features | ||
| F32.4 | Major depressive disorder, single episode, in partial remission | ||
| F32.5 | Major depressive disorder, single episode, in full remission | ||
| F32.8 | Other depressive episodes | ||
| F32.9 | Major depressive disorder, single episode, unspecified | ||
| F33.0 | Major depressive disorder, recurrent, mild | ||
| F33.1 | Major depressive disorder, recurrent, moderate | ||
| F33.2 | Major depressive disorder, recurrent severe without psychotic features | ||
| F33.3 | Major depressive disorder, recurrent, severe with psychotic symptoms | ||
| F33.40 | Major depressive disorder, recurrent, in remission, unspecified | ||
| F33.41 | Major depressive disorder, recurrent, in partial remission | ||
| F33.42 | Major depressive disorder, recurrent, in full remission | ||
| F33.8 | Other recurrent depressive disorders | ||
| F33.9 | Major depressive disorder, recurrent, unspecified | ||
| F34.0 | Cyclothymic disorder | ||
| F34.1 | Dysthymic disorder | ||
| F34.8 | Other persistent mood [affective] disorders | ||
| F34.9 | Persistent mood [affective] disorder, unspecified | ||
| F39 | Unspecified mood [affective] disorder | ||
| F42 | Obsessive-compulsive disorder | ||
| F43.0 | Acute stress reaction | ||
| F43.10 | Post-traumatic stress disorder, unspecified | ||
| F43.11 | Post-traumatic stress disorder, acute | ||
| F43.12 | Post-traumatic stress disorder, chronic | ||
| F43.20 | Adjustment disorder, unspecified | ||
| F43.21 | Adjustment disorder with depressed mood | ||
| F43.22 | Adjustment disorder with anxiety | ||
| F43.23 | Adjustment disorder with mixed anxiety and depressed mood | ||
| F43.24 | Adjustment disorder with disturbance of conduct | ||
| F43.25 | Adjustment disorder with mixed disturbance of emotions and conduct | ||
| F43.29 | Adjustment disorder with other symptoms | ||
| F43.8 | Other reactions to severe stress | ||
| F43.9 | Reaction to severe stress, unspecified | ||
| F44.89 | Other dissociative and conversion disorders | ||
| F53 | Puerperal psychosis | ||
| F60.0 | Paranoid personality disorder | ||
| F60.1 | Schizoid personality disorder | ||
| F60.2 | Antisocial personality disorder | ||
| F60.3 | Borderline personality disorder | ||
| F60.4 | Histrionic personality disorder | ||
| F60.5 | Obsessive-compulsive personality disorder | ||
| F60.6 | Avoidant personality disorder | ||
| F60.7 | Dependent personality disorder | ||
| F60.81 | Narcissistic personality disorder | ||
| F60.89 | Other specific personality disorders | ||
| F60.9 | Personality disorder, unspecified | ||
| F63.0 | Pathological gambling | ||
| F63.1 | Pyromania | ||
| F63.2 | Kleptomania | ||
| F63.3 | Trichotillomania | ||
| F63.81 | Intermittent explosive disorder | ||
| F63.89 | Other impulse disorders | ||
| F63.9 | Impulse disorder, unspecified | ||
| F68.10 | Factitious disorder imposed on self, unspecified | ||
| F68.11 | Factitious disorder imposed on self, with predominantly psychological signs and symptoms | ||
| F68.12 | Factitious disorder imposed on self, with predominantly physical signs and symptoms | ||
| F68.13 | Factitious disorder imposed on self, with combined psychological and physical signs and symptoms | ||
| F68.8 | Other specified disorders of adult personality and behavior | ||
| F84.0 | Autistic disorder | ||
| F84.2 | Rett's syndrome | ||
| F84.3 | Other childhood disintegrative disorder | ||
| F84.5 | Asperger's syndrome | ||
| F84.8 | Other pervasive developmental disorders | ||
| F84.9 | Pervasive developmental disorder, unspecified | ||
| F90.0 | Attention-deficit hyperactivity disorder, predominantly inattentive type | ||
| F90.1 | Attention-deficit hyperactivity disorder, predominantly hyperactive type | ||
| F90.2 | Attention-deficit hyperactivity disorder, combined type | ||
| F90.8 | Attention-deficit hyperactivity disorder, other type | ||
| F90.9 | Attention-deficit hyperactivity disorder, unspecified type | ||
| F91.0 | Conduct disorder confined to family context | ||
| F91.1 | Conduct disorder, childhood-onset type | ||
| F91.2 | Conduct disorder, adolescent-onset type | ||
| F91.3 | Oppositional defiant disorder | ||
| F91.8 | Other conduct disorders | ||
| F91.9 | Conduct disorder, unspecified | ||
| F93.0 | Separation anxiety disorder of childhood | ||
| F93.8 | Other childhood emotional disorders | ||
| F93.9 | Childhood emotional disorder, unspecified | ||
| F94.0 | Selective mutism | ||
| F94.1 | Reactive attachment disorder of childhood | ||
| F94.2 | Disinhibited attachment disorder of childhood | ||
| F94.8 | Other childhood disorders of social functioning | ||
| F94.9 | Childhood disorder of social functioning, unspecified | ||
| F20.0 | Paranoid schizophrenia | ||
| F20.1 | Disorganized schizophrenia | ||
| F20.2 | Catatonic schizophrenia | ||
| F20.3 | Undifferentiated schizophrenia | ||
| F20.5 | Residual schizophrenia | ||
| F20.81 | Schizophreniform disorder | ||
| F20.89 | Other schizophrenia | ||
| F20.9 | Schizophrenia, unspecified | ||
| F21 | Schizotypal disorder | ||
| F22 | Delusional disorders | ||
| F23 | Brief psychotic disorder | ||
| F24 | Shared psychotic disorder | ||
| F25.0 | Schizoaffective disorder, bipolar type | ||
| F25.1 | Schizoaffective disorder, depressive type | ||
| F25.8 | Other schizoaffective disorders | ||
| F25.9 | Schizoaffective disorder, unspecified | ||
| F28 | Other psychotic disorder not due to a substance or known physiological condition | ||
| F29 | Unspecified psychosis not due to a substance or known physiological condition | ||
| F30.10 | Manic episode without psychotic symptoms, unspecified | ||
| F30.11 | Manic episode without psychotic symptoms, mild | ||
| F30.12 | Manic episode without psychotic symptoms, moderate | ||
| F30.13 | Manic episode, severe, without psychotic symptoms | ||
| F30.2 | Manic episode, severe with psychotic symptoms | ||
| F30.3 | Manic episode in partial remission | ||
| F30.4 | Manic episode in full remission | ||
| F30.8 | Other manic episodes | ||
| F30.9 | Manic episode, unspecified | ||
| F31.0 | Bipolar disorder, current episode hypomanic | ||
| F31.10 | Bipolar disorder, current episode manic without psychotic features, unspecified | ||
| F31.11 | Bipolar disorder, current episode manic without psychotic features, mild | ||
| F31.12 | Bipolar disorder, current episode manic without psychotic features, moderate | ||
| F31.13 | Bipolar disorder, current episode manic without psychotic features, severe | ||
| F31.2 | Bipolar disorder, current episode manic severe with psychotic features | ||
| F31.30 | Bipolar disorder, current episode depressed, mild or moderate severity, unspecified | ||
| F31.31 | Bipolar disorder, current episode depressed, mild | ||
| F31.32 | Bipolar disorder, current episode depressed, moderate | ||
| F31.4 | Bipolar disorder, current episode depressed, severe, without psychotic features | ||
| F31.5 | Bipolar disorder, current episode depressed, severe, with psychotic features | ||
| F31.60 | Bipolar disorder, current episode mixed, unspecified | ||
| F31.61 | Bipolar disorder, current episode mixed, mild | ||
| F31.62 | Bipolar disorder, current episode mixed, moderate | ||
| F31.63 | Bipolar disorder, current episode mixed, severe, without psychotic features | ||
| F31.64 | Bipolar disorder, current episode mixed, severe, with psychotic features | ||
| F31.70 | Bipolar disorder, currently in remission, most recent episode unspecified | ||
| F31.71 | Bipolar disorder, in partial remission, most recent episode hypomanic | ||
| F31.72 | Bipolar disorder, in full remission, most recent episode hypomanic | ||
| F31.73 | Bipolar disorder, in partial remission, most recent episode manic | ||
| F31.74 | Bipolar disorder, in full remission, most recent episode manic | ||
| F31.75 | Bipolar disorder, in partial remission, most recent episode depressed | ||
| F31.76 | Bipolar disorder, in full remission, most recent episode depressed | ||
| F31.77 | Bipolar disorder, in partial remission, most recent episode mixed | ||
| F31.78 | Bipolar disorder, in full remission, most recent episode mixed | ||
| F31.81 | Bipolar II disorder | ||
| F31.89 | Other bipolar disorder | ||
| F31.9 | Bipolar disorder, unspecified | ||
| F32.0 | Major depressive disorder, single episode, mild | ||
| F32.1 | Major depressive disorder, single episode, moderate | ||
| F32.2 | Major depressive disorder, single episode, severe without psychotic features | ||
| F32.3 | Major depressive disorder, single episode, severe with psychotic features | ||
| F32.4 | Major depressive disorder, single episode, in partial remission | ||
| F32.5 | Major depressive disorder, single episode, in full remission | ||
| F32.8 | Other depressive episodes | ||
| F32.9 | Major depressive disorder, single episode, unspecified | ||
| F33.0 | Major depressive disorder, recurrent, mild | ||
| F33.1 | Major depressive disorder, recurrent, moderate | ||
| F33.2 | Major depressive disorder, recurrent severe without psychotic features | ||
| F33.3 | Major depressive disorder, recurrent, severe with psychotic symptoms | ||
| F33.40 | Major depressive disorder, recurrent, in remission, unspecified | ||
| F33.41 | Major depressive disorder, recurrent, in partial remission | ||
| F33.42 | Major depressive disorder, recurrent, in full remission | ||
| F33.8 | Other recurrent depressive disorders | ||
| F33.9 | Major depressive disorder, recurrent, unspecified | ||
| F34.0 | Cyclothymic disorder | ||
| F34.1 | Dysthymic disorder | ||
| F34.8 | Other persistent mood [affective] disorders | ||
| F34.9 | Persistent mood [affective] disorder, unspecified | ||
| F39 | Unspecified mood [affective] disorder | ||
| F42 | Obsessive-compulsive disorder | ||
| F43.0 | Acute stress reaction | ||
| F43.10 | Post-traumatic stress disorder, unspecified | ||
| F43.11 | Post-traumatic stress disorder, acute | ||
| F43.12 | Post-traumatic stress disorder, chronic | ||
| F43.20 | Adjustment disorder, unspecified | ||
| F43.21 | Adjustment disorder with depressed mood | ||
| F43.22 | Adjustment disorder with anxiety | ||
| F43.23 | Adjustment disorder with mixed anxiety and depressed mood | ||
| F43.24 | Adjustment disorder with disturbance of conduct | ||
| F43.25 | Adjustment disorder with mixed disturbance of emotions and conduct | ||
| F43.29 | Adjustment disorder with other symptoms | ||
| F43.8 | Other reactions to severe stress | ||
| F43.9 | Reaction to severe stress, unspecified | ||
| F44.89 | Other dissociative and conversion disorders | ||
| F53 | Puerperal psychosis | ||
| F60.0 | Paranoid personality disorder | ||
| F60.1 | Schizoid personality disorder | ||
| F60.2 | Antisocial personality disorder | ||
| F60.3 | Borderline personality disorder | ||
| F60.4 | Histrionic personality disorder | ||
| F60.5 | Obsessive-compulsive personality disorder | ||
| F60.6 | Avoidant personality disorder | ||
| F60.7 | Dependent personality disorder | ||
| F60.81 | Narcissistic personality disorder | ||
| F60.89 | Other specific personality disorders | ||
| F60.9 | Personality disorder, unspecified | ||
| F63.0 | Pathological gambling | ||
| F63.1 | Pyromania | ||
| F63.2 | Kleptomania | ||
| F63.3 | Trichotillomania | ||
| F63.81 | Intermittent explosive disorder | ||
| F63.89 | Other impulse disorders | ||
| F63.9 | Impulse disorder, unspecified | ||
| F68.10 | Factitious disorder imposed on self, unspecified | ||
| F68.11 | Factitious disorder imposed on self, with predominantly psychological signs and symptoms | ||
| F68.12 | Factitious disorder imposed on self, with predominantly physical signs and symptoms | ||
| F68.13 | Factitious disorder imposed on self, with combined psychological and physical signs and symptoms | ||
| F68.8 | Other specified disorders of adult personality and behavior | ||
| F84.0 | Autistic disorder | ||
| F84.2 | Rett's syndrome | ||
| F84.3 | Other childhood disintegrative disorder | ||
| F84.5 | Asperger's syndrome | ||
| F84.8 | Other pervasive developmental disorders | ||
| F84.9 | Pervasive developmental disorder, unspecified | ||
| F90.0 | Attention-deficit hyperactivity disorder, predominantly inattentive type | ||
| F90.1 | Attention-deficit hyperactivity disorder, predominantly hyperactive type | ||
| F90.2 | Attention-deficit hyperactivity disorder, combined type | ||
| F90.8 | Attention-deficit hyperactivity disorder, other type | ||
| F90.9 | Attention-deficit hyperactivity disorder, unspecified type | ||
| F91.0 | Conduct disorder confined to family context | ||
| F91.1 | Conduct disorder, childhood-onset type | ||
| F91.2 | Conduct disorder, adolescent-onset type | ||
| F91.3 | Oppositional defiant disorder | ||
| F91.8 | Other conduct disorders | ||
| F91.9 | Conduct disorder, unspecified | ||
| F93.0 | Separation anxiety disorder of childhood | ||
| F93.8 | Other childhood emotional disorders | ||
| F93.9 | Childhood emotional disorder, unspecified | ||
| F94.0 | Selective mutism | ||
| F94.1 | Reactive attachment disorder of childhood | ||
| F94.2 | Disinhibited attachment disorder of childhood | ||
| F94.8 | Other childhood disorders of social functioning | ||
| F94.9 | Childhood disorder of social functioning, 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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