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

PQRS Measure

#59Empiric Antibiotic for Community-Acquired Bacterial Pneumonia
 Description/Specifications Data Collection Sheet 

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
4045FAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F8PAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F1PAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F2PAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F3PAppropriate empiric antibiotic prescribed (CAP), (EM)
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.
99241Office consultation for a new or established 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 self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99242Office or other outpatient consultation for a new or 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.
99243Office or other outpatient consultation for a new or 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.
99244Office or other outpatient consultation for a new or 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.
99245Office or other outpatient consultation for a new or 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, 55 minutes must be met or exceeded.
99281Emergency 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
99282Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
99283Emergency 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
99284Emergency 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
99285Emergency 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
9929123Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

ICD9 Codes

CodeModifierPOSDescription
481Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia]
482.0Pneumonia due to Klebsiella pneumoniae
482.1Pneumonia due to Pseudomonas
482.2Pneumonia due to Hemophilus influenzae [H. influenzae]
482.30Pneumonia due to Streptococcus, unspecified
482.31Pneumonia due to Streptococcus, group A
482.32Pneumonia due to Streptococcus, group B
482.39Pneumonia due to other Streptococcus
482.40Pneumonia due to Staphylococcus, unspecified
482.41Methicillin susceptible pneumonia due to Staphylococcus aureus
482.49Other Staphylococcus pneumonia
482.81Pneumonia due to anaerobes
482.82Pneumonia due to escherichia coli [E. coli]
482.83Pneumonia due to other gram-negative bacteria
482.84Pneumonia due to Legionnaires' disease
482.89Pneumonia due to other specified bacteria
482.9Bacterial pneumonia, unspecified
483.0Pneumonia due to mycoplasma pneumoniae
483.1Pneumonia due to chlamydia
483.8Pneumonia due to other specified organism
485Bronchopneumonia, organism unspecified
486Pneumonia, organism unspecified
487.0Influenza with pneumonia
Legend:
Registry OKThis measure can be submitted through registry.
EHR OKThis measure can be submitted via Electronic Health Record (EHR).

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