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

PQRS Measure

#131Pain Assessment and Follow-Up
 Report via: Claim, Registry

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
90801N/AN/APsychiatric diagnostic interview examination
90802N/AN/AInteractive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication
96116N/AN/ANeurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour
96150N/AN/AHealth and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment
97001N/AN/APhysical therapy evaluation
97003N/AN/AOccupational therapy evaluation
98940N/AN/AChiropractic manipulative treatment (CMT); spinal, 1-2 regions
98941N/AN/AChiropractic manipulative treatment (CMT); spinal, 3-4 regions
98942N/AN/AChiropractic manipulative treatment (CMT); spinal, 5 regions
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.
G0101N/AN/A

HCPCS Codes

CodeModifierPOSDescription
G0402N/AN/AInitial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
G0438N/AN/AAnnual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439N/AN/AAnnual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
G8442N/AN/APain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter
G8509N/AN/APain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
G8730N/AN/APain assessment documented as positive using a standardized tool and a follow-up plan is documented
G8731N/AN/APain assessment using a standardized tool is documented as negative, no follow-up plan required
G8732N/AN/ANo documentation of pain assessment, reason not given
G8509N/AN/APain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
G8730N/AN/APain assessment documented as positive using a standardized tool and a follow-up plan is documented
G8731N/AN/APain assessment using a standardized tool is documented as negative, no follow-up plan required
G8732N/AN/ANo documentation of pain assessment, reason not given
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 IThis measure can be submitted via Group Practice Reporting Option 1.
GPRO IIThis measure can be submitted via Group Practice Reporting Option 2.

More information on these alternative reporting mechanisms is available at:
    http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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