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PQRS Measure

 Report via: Claim, Registry

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
99219N/AN/AInitial observation care, per day, for the evaluation and management of a 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 problem(s) requiring admission to outpatient hospital "observation status" are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit.
99220N/AN/AInitial observation care, per day, for the evaluation and management of a 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 problem(s) requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.
99221N/AN/AInitial 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.
99222N/AN/AInitial 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.
99223N/AN/AInitial 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.
99234N/AN/AHospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, 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, 45 minutes must be met or exceeded.
99235N/AN/AHospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, 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, 70 minutes must be met or exceeded.
99236N/AN/AHospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, 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, 85 minutes must be met or exceeded.
99281N/AN/AEmergency 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
99282N/AN/AEmergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
99283N/AN/AEmergency 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
99284N/AN/AEmergency 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
99285N/AN/AEmergency 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
99291N/AN/ACritical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
6010FN/AN/ADysphagia screening conducted prior to order for or receipt of any foods, fluids, or medication by mouth (STR)
6010F1PN/ADysphagia screening conducted prior to order for or receipt of any foods, fluids, or medication by mouth (STR)
6010FN/AN/ADysphagia screening conducted prior to order for or receipt of any foods, fluids, or medication by mouth (STR)
6010F8PN/ADysphagia screening conducted prior to order for or receipt of any foods, fluids, or medication by mouth (STR)
6010F8PN/ADysphagia screening conducted prior to order for or receipt of any foods, fluids, or medication by mouth (STR)
6010F2PN/ADysphagia screening conducted prior to order for or receipt of any foods, fluids, or medication by mouth (STR)
6015FN/AN/APatient receiving or eligible to receive foods, fluids, or medication by mouth (STR)
6015FN/AN/APatient receiving or eligible to receive foods, fluids, or medication by mouth (STR)
6015FN/AN/APatient receiving or eligible to receive foods, fluids, or medication by mouth (STR)
6015FN/AN/APatient receiving or eligible to receive foods, fluids, or medication by mouth (STR)
6020FN/AN/ANPO (nothing by mouth) ordered (STR)
99218N/AN/AInitial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or 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 problem(s) requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.

ICD9 Codes

CodeModifierPOSDescription
430N/AN/ASubarachnoid hemorrhage
431N/AN/AIntracerebral hemorrhage
432.0N/AN/ANontraumatic extradural hemorrhage
432.1N/AN/ASubdural hemorrhage
432.9N/AN/AUnspecified intracranial hemorrhage
433.01N/AN/AOcclusion and stenosis of basilar artery with cerebral infarction
433.11N/AN/AOcclusion and stenosis of carotid artery with cerebral infarction
433.21N/AN/AOcclusion and stenosis of vertebral artery with cerebral infarction
433.31N/AN/AOcclusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction
433.81N/AN/AOcclusion and stenosis of other specified precerebral artery with cerebral infarction
433.91N/AN/AOcclusion and stenosis of unspecified precerebral artery with cerebral infarction
434.01N/AN/ACerebral thrombosis with cerebral infarction
434.11N/AN/ACerebral embolism with cerebral infarction
434.91N/AN/ACerebral artery occlusion, unspecified with cerebral infarction

ICD10CM Codes

CodeModifierPOSDescription
I60.00N/AN/ANontraumatic subarachnoid hemorrhage from unspecified carotid siphon and bifurcation
I60.01N/AN/ANontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02N/AN/ANontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.10N/AN/ANontraumatic subarachnoid hemorrhage from unspecified middle cerebral artery
I60.11N/AN/ANontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12N/AN/ANontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.20N/AN/ANontraumatic subarachnoid hemorrhage from unspecified anterior communicating artery
I60.21N/AN/ANontraumatic subarachnoid hemorrhage from right anterior communicating artery
I60.22N/AN/ANontraumatic subarachnoid hemorrhage from left anterior communicating artery
I60.30N/AN/ANontraumatic subarachnoid hemorrhage from unspecified posterior communicating artery
I60.31N/AN/ANontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32N/AN/ANontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4N/AN/ANontraumatic subarachnoid hemorrhage from basilar artery
I60.50N/AN/ANontraumatic subarachnoid hemorrhage from unspecified vertebral artery
I60.51N/AN/ANontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52N/AN/ANontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6N/AN/ANontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.7N/AN/ANontraumatic subarachnoid hemorrhage from unspecified intracranial artery
I60.8N/AN/AOther nontraumatic subarachnoid hemorrhage
I60.9N/AN/ANontraumatic subarachnoid hemorrhage, unspecified
I61.0N/AN/ANontraumatic intracerebral hemorrhage in hemisphere, subcortical
I61.1N/AN/ANontraumatic intracerebral hemorrhage in hemisphere, cortical
I61.2N/AN/ANontraumatic intracerebral hemorrhage in hemisphere, unspecified
I61.3N/AN/ANontraumatic intracerebral hemorrhage in brain stem
I61.4N/AN/ANontraumatic intracerebral hemorrhage in cerebellum
I61.5N/AN/ANontraumatic intracerebral hemorrhage, intraventricular
I61.6N/AN/ANontraumatic intracerebral hemorrhage, multiple localized
I61.8N/AN/AOther nontraumatic intracerebral hemorrhage
I61.9N/AN/ANontraumatic intracerebral hemorrhage, unspecified
I62.00N/AN/ANontraumatic subdural hemorrhage, unspecified
I62.01N/AN/ANontraumatic acute subdural hemorrhage
I62.02N/AN/ANontraumatic subacute subdural hemorrhage
I62.03N/AN/ANontraumatic chronic subdural hemorrhage
I62.1N/AN/ANontraumatic extradural hemorrhage
I62.9N/AN/ANontraumatic intracranial hemorrhage, unspecified
I63.00N/AN/ACerebral infarction due to thrombosis of unspecified precerebral artery
I63.011N/AN/ACerebral infarction due to thrombosis of right vertebral artery
I63.012N/AN/ACerebral infarction due to thrombosis of left vertebral artery
I63.019N/AN/ACerebral infarction due to thrombosis of unspecified vertebral artery
I63.02N/AN/ACerebral infarction due to thrombosis of basilar artery
I63.031N/AN/ACerebral infarction due to thrombosis of right carotid artery
I63.032N/AN/ACerebral infarction due to thrombosis of left carotid artery
I63.039N/AN/ACerebral infarction due to thrombosis of unspecified carotid artery
I63.09N/AN/ACerebral infarction due to thrombosis of other precerebral artery
I63.10N/AN/ACerebral infarction due to embolism of unspecified precerebral artery
I63.111N/AN/ACerebral infarction due to embolism of right vertebral artery
I63.112N/AN/ACerebral infarction due to embolism of left vertebral artery
I63.119N/AN/ACerebral infarction due to embolism of unspecified vertebral artery
I63.12N/AN/ACerebral infarction due to embolism of basilar artery
I63.131N/AN/ACerebral infarction due to embolism of right carotid artery
I63.132N/AN/ACerebral infarction due to embolism of left carotid artery
I63.139N/AN/ACerebral infarction due to embolism of unspecified carotid artery
I63.19N/AN/ACerebral infarction due to embolism of other precerebral artery
I63.20N/AN/ACerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries
I63.211N/AN/ACerebral infarction due to unspecified occlusion or stenosis of right vertebral artery
I63.212N/AN/ACerebral infarction due to unspecified occlusion or stenosis of left vertebral artery
I63.219N/AN/ACerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery
I63.22N/AN/ACerebral infarction due to unspecified occlusion or stenosis of basilar artery
I63.231N/AN/ACerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232N/AN/ACerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.239N/AN/ACerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery
I63.29N/AN/ACerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries
I63.30N/AN/ACerebral infarction due to thrombosis of unspecified cerebral artery
I63.311N/AN/ACerebral infarction due to thrombosis of right middle cerebral artery
I63.312N/AN/ACerebral infarction due to thrombosis of left middle cerebral artery
I63.319N/AN/ACerebral infarction due to thrombosis of unspecified middle cerebral artery
I63.321N/AN/ACerebral infarction due to thrombosis of right anterior cerebral artery
I63.322N/AN/ACerebral infarction due to thrombosis of left anterior cerebral artery
I63.329N/AN/ACerebral infarction due to thrombosis of unspecified anterior cerebral artery
I63.331N/AN/ACerebral infarction due to thrombosis of right posterior cerebral artery
I63.332N/AN/ACerebral infarction due to thrombosis of left posterior cerebral artery
I63.339N/AN/ACerebral infarction due to thrombosis of unspecified posterior cerebral artery
I63.341N/AN/ACerebral infarction due to thrombosis of right cerebellar artery
I63.342N/AN/ACerebral infarction due to thrombosis of left cerebellar artery
I63.349N/AN/ACerebral infarction due to thrombosis of unspecified cerebellar artery
I63.39N/AN/ACerebral infarction due to thrombosis of other cerebral artery
I63.40N/AN/ACerebral infarction due to embolism of unspecified cerebral artery
I63.411N/AN/ACerebral infarction due to embolism of right middle cerebral artery
I63.412N/AN/ACerebral infarction due to embolism of left middle cerebral artery
I63.419N/AN/ACerebral infarction due to embolism of unspecified middle cerebral artery
I63.421N/AN/ACerebral infarction due to embolism of right anterior cerebral artery
I63.422N/AN/ACerebral infarction due to embolism of left anterior cerebral artery
I63.429N/AN/ACerebral infarction due to embolism of unspecified anterior cerebral artery
I63.431N/AN/ACerebral infarction due to embolism of right posterior cerebral artery
I63.432N/AN/ACerebral infarction due to embolism of left posterior cerebral artery
I63.439N/AN/ACerebral infarction due to embolism of unspecified posterior cerebral artery
I63.441N/AN/ACerebral infarction due to embolism of right cerebellar artery
I63.442N/AN/ACerebral infarction due to embolism of left cerebellar artery
I63.449N/AN/ACerebral infarction due to embolism of unspecified cerebellar artery
I63.49N/AN/ACerebral infarction due to embolism of other cerebral artery
I63.50N/AN/ACerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
I63.511N/AN/ACerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512N/AN/ACerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.519N/AN/ACerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery
I63.521N/AN/ACerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522N/AN/ACerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.529N/AN/ACerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery
I63.531N/AN/ACerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532N/AN/ACerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.539N/AN/ACerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery
I63.541N/AN/ACerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542N/AN/ACerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.549N/AN/ACerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery
I63.59N/AN/ACerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6N/AN/ACerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.8N/AN/AOther cerebral infarction
I63.9N/AN/ACerebral infarction, 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).
GPRO/ACOThis 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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