PQRS Measure
Report via: Claim, Registry
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. |
| 99281 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | N/A | 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 | N/A | 23 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes |
| 99324 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new 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 of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver. |
| 99325 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making 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 presenting problem(s) are of moderate severity. Typically, 30 minutes are spent with the patient and/or family or caregiver. |
| 99326 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed 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 presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver. |
| 99327 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new 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 presenting problem(s) are of high severity. Typically, 60 minutes are spent with the patient and/or family or caregiver. |
| 99328 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of a new 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 patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver. |
| 99334 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval 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, 15 minutes are spent with the patient and/or family or caregiver. |
| 99335 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of an established 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 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 presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver. |
| 99336 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed 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 presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver. |
| 99337 | N/A | N/A | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to 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 presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver. |
| 99341 | N/A | N/A | Home or residence 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. |
| 99342 | N/A | N/A | Home or residence 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. |
| 99343 | N/A | N/A | Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed 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 presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| 99344 | N/A | N/A | Home or residence 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, 60 minutes must be met or exceeded. |
| 99345 | N/A | N/A | Home or residence 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, 75 minutes must be met or exceeded. |
| 99347 | N/A | N/A | Home or residence 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, 20 minutes must be met or exceeded. |
| 99348 | N/A | N/A | Home or residence 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, 30 minutes must be met or exceeded. |
| 99349 | N/A | N/A | Home or residence 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, 40 minutes must be met or exceeded. |
| 99350 | N/A | N/A | Home or residence 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, 60 minutes must be met or exceeded. |
| 2010F | N/A | N/A | Vital signs (temperature, pulse, respiratory rate, and blood pressure) documented and reviewed (CAP) (EM) |
| 2010F | 8P | N/A | Vital signs (temperature, pulse, respiratory rate, and blood pressure) documented and reviewed (CAP) (EM) |
ICD9 Codes | |||
| Code | Modifier | POS | Description |
| 481 | N/A | N/A | Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia] |
| 482.0 | N/A | N/A | Pneumonia due to Klebsiella pneumoniae |
| 482.1 | N/A | N/A | Pneumonia due to Pseudomonas |
| 482.2 | N/A | N/A | Pneumonia due to Hemophilus influenzae [H. influenzae] |
| 482.30 | N/A | N/A | Pneumonia due to Streptococcus, unspecified |
| 482.31 | N/A | N/A | Pneumonia due to Streptococcus, group A |
| 482.32 | N/A | N/A | Pneumonia due to Streptococcus, group B |
| 482.39 | N/A | N/A | Pneumonia due to other Streptococcus |
| 482.40 | N/A | N/A | Pneumonia due to Staphylococcus, unspecified |
| 482.41 | N/A | N/A | Methicillin susceptible pneumonia due to Staphylococcus aureus |
| 482.42 | N/A | N/A | Methicillin resistant pneumonia due to Staphylococcus aureus |
| 482.49 | N/A | N/A | Other Staphylococcus pneumonia |
| 482.81 | N/A | N/A | Pneumonia due to anaerobes |
| 482.82 | N/A | N/A | Pneumonia due to escherichia coli [E. coli] |
| 482.83 | N/A | N/A | Pneumonia due to other gram-negative bacteria |
| 482.84 | N/A | N/A | Pneumonia due to Legionnaires' disease |
| 482.89 | N/A | N/A | Pneumonia due to other specified bacteria |
| 482.9 | N/A | N/A | Bacterial pneumonia, unspecified |
| 483.0 | N/A | N/A | Pneumonia due to mycoplasma pneumoniae |
| 483.1 | N/A | N/A | Pneumonia due to chlamydia |
| 483.8 | N/A | N/A | Pneumonia due to other specified organism |
| 485 | N/A | N/A | Bronchopneumonia, organism unspecified |
| 486 | N/A | N/A | Pneumonia, organism unspecified |
ICD10CM Codes | |||
| Code | Modifier | POS | Description |
| A48.1 | N/A | N/A | Legionnaires' disease |
| J13 | N/A | N/A | Pneumonia due to Streptococcus pneumoniae |
| J14 | N/A | N/A | Pneumonia due to Hemophilus influenzae |
| J15.0 | N/A | N/A | Pneumonia due to Klebsiella pneumoniae |
| J15.1 | N/A | N/A | Pneumonia due to Pseudomonas |
| J15.20 | N/A | N/A | Pneumonia due to staphylococcus, unspecified |
| J15.211 | N/A | N/A | Pneumonia due to Methicillin susceptible Staphylococcus aureus |
| J15.212 | N/A | N/A | Pneumonia due to Methicillin resistant Staphylococcus aureus |
| J15.29 | N/A | N/A | Pneumonia due to other staphylococcus |
| J15.3 | N/A | N/A | Pneumonia due to streptococcus, group B |
| J15.4 | N/A | N/A | Pneumonia due to other streptococci |
| J15.5 | N/A | N/A | Pneumonia due to Escherichia coli |
| J15.6 | N/A | N/A | Pneumonia due to other Gram-negative bacteria |
| J15.7 | N/A | N/A | Pneumonia due to Mycoplasma pneumoniae |
| J15.8 | N/A | N/A | Pneumonia due to other specified bacteria |
| J15.9 | N/A | N/A | Unspecified bacterial pneumonia |
| J16.0 | N/A | N/A | Chlamydial pneumonia |
| J16.8 | N/A | N/A | Pneumonia due to other specified infectious organisms |
| J18.0 | N/A | N/A | Bronchopneumonia, unspecified organism |
| J18.1 | N/A | N/A | Lobar pneumonia, unspecified organism |
| J18.8 | N/A | N/A | Other pneumonia, unspecified organism |
| J18.9 | N/A | N/A | Pneumonia, unspecified organism |
| Z16 | N/A | N/A | |
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/ACOThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
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/ACOThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.
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