PQRS Measure
#161HIV/AIDS: Adolescent and Adult Patients with HIV/AIDS Who Are Prescribed Potent Antiretroviral Therapy
Report via: Registry, Measure Group
The following codes apply for this PQRS measure:
CPT Codes | |||
| Code | Modifier | POS | Description |
|---|---|---|---|
| 99201 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 3490F | N/A | N/A | History of AIDS-defining condition (HIV) |
| 3492F | N/A | N/A | History of nadir CD4+ cell count <350 cells/mm3 (HIV) |
| 3493F | N/A | N/A | No history of nadir CD4+ cell count <350 cells/mm3 and no history of AIDS-defining condition (HIV) |
| 4276F | 8P | N/A | Potent antiretroviral therapy prescribed (HIV) |
| 4276F | N/A | N/A | Potent antiretroviral therapy prescribed (HIV) |
| 99201 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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. |
| 4276F | 8P | N/A | Potent antiretroviral therapy prescribed (HIV) |
| 4276F | N/A | N/A | Potent antiretroviral therapy prescribed (HIV) |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 042 | N/A | N/A | Human immunodeficiency virus [HIV] disease |
| 079.53 | N/A | N/A | Human immunodeficiency virus, type 2 [HIV-2] |
| V08 | N/A | N/A | Asymptomatic human immunodeficiency virus [HIV] infection status |
| 042 | N/A | N/A | Human immunodeficiency virus [HIV] disease |
| 079.53 | N/A | N/A | Human immunodeficiency virus, type 2 [HIV-2] |
| V08 | N/A | N/A | Asymptomatic human immunodeficiency virus [HIV] infection status |
| V22.0 | N/A | N/A | Supervision of normal first pregnancy |
| V22.1 | N/A | N/A | Supervision of other normal pregnancy |
| V22.2 | N/A | N/A | Pregnant state, incidental |
| V23.0 | N/A | N/A | Supervision of high-risk pregnancy with history of infertility |
| V23.1 | N/A | N/A | Supervision of high-risk pregnancy with history of trophoblastic disease |
| V23.2 | N/A | N/A | Supervision of high-risk pregnancy with history of abortion |
| V23.3 | N/A | N/A | Supervision of high-risk pregnancy with grand multiparity |
| V23.41 | N/A | N/A | Pregnancy with history of pre-term labor |
| V23.42 | N/A | N/A | Pregnancy with history of ectopic pregnancy |
| V23.49 | N/A | N/A | Pregnancy with other poor obstetric history |
| V23.5 | N/A | N/A | Supervision of high-risk pregnancy with other poor reproductive history |
| V23.7 | N/A | N/A | Supervision of high-risk pregnancy with insufficient prenatal care |
| V23.81 | N/A | N/A | Supervision of high-risk pregnancy with elderly primigravida |
| V23.82 | N/A | N/A | Supervision of high-risk pregnancy with elderly multigravida |
| V23.83 | N/A | N/A | Supervision of high-risk pregnancy with young primigravida |
| V23.84 | N/A | N/A | Supervision of high-risk pregnancy with young multigravida |
| V23.87 | N/A | N/A | Pregnancy with inconclusive fetal viability |
| V23.89 | N/A | N/A | Supervision of other high-risk pregnancy |
| V23.9 | N/A | N/A | Supervision of unspecified high-risk pregnancy |
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.
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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