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PQRS Measure

 Report via: Claim, Registry

The following codes apply for this PQRS measure:

CPT Codes

CodeModifierPOSDescription
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.
99324N/AN/ADomiciliary 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.
99325N/AN/ADomiciliary 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.
99326N/AN/ADomiciliary 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.
99327N/AN/ADomiciliary 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.
99328N/AN/ADomiciliary 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.
99334N/AN/ADomiciliary 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.
99335N/AN/ADomiciliary 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.
99336N/AN/ADomiciliary 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.
99337N/AN/ADomiciliary 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.
99341N/AN/AHome 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.
99342N/AN/AHome 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.
99343N/AN/AHome 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.
99344N/AN/AHome 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.
99345N/AN/AHome 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.
99347N/AN/AHome 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.
99348N/AN/AHome 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.
99349N/AN/AHome 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.
99350N/AN/AHome 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.
4045FN/AN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F8PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F1PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F2PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F3PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045FN/AN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F8PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
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/A23Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
4045FN/AN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F8PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F1PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F2PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F3PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045FN/AN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F8PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
99221A1N/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.
99222A1N/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.
99223A1N/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.
4045FN/AN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F8PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F1PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F2PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F3PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045FN/AN/AAppropriate empiric antibiotic prescribed (CAP), (EM)
4045F8PN/AAppropriate empiric antibiotic prescribed (CAP), (EM)

ICD9 Codes

CodeModifierPOSDescription
481N/AN/APneumococcal pneumonia [Streptococcus pneumoniae pneumonia]
482.0N/AN/APneumonia due to Klebsiella pneumoniae
482.1N/AN/APneumonia due to Pseudomonas
482.2N/AN/APneumonia due to Hemophilus influenzae [H. influenzae]
482.30N/AN/APneumonia due to Streptococcus, unspecified
482.31N/AN/APneumonia due to Streptococcus, group A
482.32N/AN/APneumonia due to Streptococcus, group B
482.39N/AN/APneumonia due to other Streptococcus
482.40N/AN/APneumonia due to Staphylococcus, unspecified
482.41N/AN/AMethicillin susceptible pneumonia due to Staphylococcus aureus
482.42N/AN/AMethicillin resistant pneumonia due to Staphylococcus aureus
482.49N/AN/AOther Staphylococcus pneumonia
482.81N/AN/APneumonia due to anaerobes
482.82N/AN/APneumonia due to escherichia coli [E. coli]
482.83N/AN/APneumonia due to other gram-negative bacteria
482.84N/AN/APneumonia due to Legionnaires' disease
482.89N/AN/APneumonia due to other specified bacteria
482.9N/AN/ABacterial pneumonia, unspecified
483.0N/AN/APneumonia due to mycoplasma pneumoniae
483.1N/AN/APneumonia due to chlamydia
483.8N/AN/APneumonia due to other specified organism
485N/AN/ABronchopneumonia, organism unspecified
486N/AN/APneumonia, organism unspecified
481N/AN/APneumococcal pneumonia [Streptococcus pneumoniae pneumonia]
482.0N/AN/APneumonia due to Klebsiella pneumoniae
482.1N/AN/APneumonia due to Pseudomonas
482.2N/AN/APneumonia due to Hemophilus influenzae [H. influenzae]
482.30N/AN/APneumonia due to Streptococcus, unspecified
482.31N/AN/APneumonia due to Streptococcus, group A
482.32N/AN/APneumonia due to Streptococcus, group B
482.39N/AN/APneumonia due to other Streptococcus
482.40N/AN/APneumonia due to Staphylococcus, unspecified
482.41N/AN/AMethicillin susceptible pneumonia due to Staphylococcus aureus
482.42N/AN/AMethicillin resistant pneumonia due to Staphylococcus aureus
482.49N/AN/AOther Staphylococcus pneumonia
482.81N/AN/APneumonia due to anaerobes
482.82N/AN/APneumonia due to escherichia coli [E. coli]
482.83N/AN/APneumonia due to other gram-negative bacteria
482.84N/AN/APneumonia due to Legionnaires' disease
482.89N/AN/APneumonia due to other specified bacteria
482.9N/AN/ABacterial pneumonia, unspecified
483.0N/AN/APneumonia due to mycoplasma pneumoniae
483.1N/AN/APneumonia due to chlamydia
483.8N/AN/APneumonia due to other specified organism
485N/AN/ABronchopneumonia, organism unspecified
486N/AN/APneumonia, organism unspecified
481N/AN/APneumococcal pneumonia [Streptococcus pneumoniae pneumonia]
482.0N/AN/APneumonia due to Klebsiella pneumoniae
482.1N/AN/APneumonia due to Pseudomonas
482.2N/AN/APneumonia due to Hemophilus influenzae [H. influenzae]
482.30N/AN/APneumonia due to Streptococcus, unspecified
482.31N/AN/APneumonia due to Streptococcus, group A
482.32N/AN/APneumonia due to Streptococcus, group B
482.39N/AN/APneumonia due to other Streptococcus
482.40N/AN/APneumonia due to Staphylococcus, unspecified
482.41N/AN/AMethicillin susceptible pneumonia due to Staphylococcus aureus
482.42N/AN/AMethicillin resistant pneumonia due to Staphylococcus aureus
482.49N/AN/AOther Staphylococcus pneumonia
482.81N/AN/APneumonia due to anaerobes
482.82N/AN/APneumonia due to escherichia coli [E. coli]
482.83N/AN/APneumonia due to other gram-negative bacteria
482.84N/AN/APneumonia due to Legionnaires' disease
482.89N/AN/APneumonia due to other specified bacteria
482.9N/AN/ABacterial pneumonia, unspecified
483.0N/AN/APneumonia due to mycoplasma pneumoniae
483.1N/AN/APneumonia due to chlamydia
483.8N/AN/APneumonia due to other specified organism
485N/AN/ABronchopneumonia, organism unspecified
486N/AN/APneumonia, organism unspecified

ICD10CM Codes

CodeModifierPOSDescription
A48.1N/AN/ALegionnaires' disease
J13N/AN/APneumonia due to Streptococcus pneumoniae
J14N/AN/APneumonia due to Hemophilus influenzae
J15.0N/AN/APneumonia due to Klebsiella pneumoniae
J15.1N/AN/APneumonia due to Pseudomonas
J15.20N/AN/APneumonia due to staphylococcus, unspecified
J15.211N/AN/APneumonia due to Methicillin susceptible Staphylococcus aureus
J15.212N/AN/APneumonia due to Methicillin resistant Staphylococcus aureus
J15.29N/AN/APneumonia due to other staphylococcus
J15.3N/AN/APneumonia due to streptococcus, group B
J15.4N/AN/APneumonia due to other streptococci
J15.5N/AN/APneumonia due to Escherichia coli
J15.6N/AN/APneumonia due to other Gram-negative bacteria
J15.7N/AN/APneumonia due to Mycoplasma pneumoniae
J15.8N/AN/APneumonia due to other specified bacteria
J15.9N/AN/AUnspecified bacterial pneumonia
J16.0N/AN/AChlamydial pneumonia
J16.8N/AN/APneumonia due to other specified infectious organisms
J18.0N/AN/ABronchopneumonia, unspecified organism
J18.1N/AN/ALobar pneumonia, unspecified organism
J18.8N/AN/AOther pneumonia, unspecified organism
J18.9N/AN/APneumonia, unspecified organism
A48.1N/AN/ALegionnaires' disease
J13N/AN/APneumonia due to Streptococcus pneumoniae
J14N/AN/APneumonia due to Hemophilus influenzae
J15.0N/AN/APneumonia due to Klebsiella pneumoniae
J15.1N/AN/APneumonia due to Pseudomonas
J15.20N/AN/APneumonia due to staphylococcus, unspecified
J15.211N/AN/APneumonia due to Methicillin susceptible Staphylococcus aureus
J15.212N/AN/APneumonia due to Methicillin resistant Staphylococcus aureus
J15.29N/AN/APneumonia due to other staphylococcus
J15.3N/AN/APneumonia due to streptococcus, group B
J15.4N/AN/APneumonia due to other streptococci
J15.5N/AN/APneumonia due to Escherichia coli
J15.6N/AN/APneumonia due to other Gram-negative bacteria
J15.7N/AN/APneumonia due to Mycoplasma pneumoniae
J15.8N/AN/APneumonia due to other specified bacteria
J15.9N/AN/AUnspecified bacterial pneumonia
J16.0N/AN/AChlamydial pneumonia
J16.8N/AN/APneumonia due to other specified infectious organisms
J18.0N/AN/ABronchopneumonia, unspecified organism
J18.1N/AN/ALobar pneumonia, unspecified organism
J18.8N/AN/AOther pneumonia, unspecified organism
J18.9N/AN/APneumonia, unspecified organism
A48.1N/AN/ALegionnaires' disease
J13N/AN/APneumonia due to Streptococcus pneumoniae
J14N/AN/APneumonia due to Hemophilus influenzae
J15.0N/AN/APneumonia due to Klebsiella pneumoniae
J15.1N/AN/APneumonia due to Pseudomonas
J15.20N/AN/APneumonia due to staphylococcus, unspecified
J15.211N/AN/APneumonia due to Methicillin susceptible Staphylococcus aureus
J15.212N/AN/APneumonia due to Methicillin resistant Staphylococcus aureus
J15.29N/AN/APneumonia due to other staphylococcus
J15.3N/AN/APneumonia due to streptococcus, group B
J15.4N/AN/APneumonia due to other streptococci
J15.5N/AN/APneumonia due to Escherichia coli
J15.6N/AN/APneumonia due to other Gram-negative bacteria
J15.7N/AN/APneumonia due to Mycoplasma pneumoniae
J15.8N/AN/APneumonia due to other specified bacteria
J15.9N/AN/AUnspecified bacterial pneumonia
J16.0N/AN/AChlamydial pneumonia
J16.8N/AN/APneumonia due to other specified infectious organisms
J18.0N/AN/ABronchopneumonia, unspecified organism
J18.1N/AN/ALobar pneumonia, unspecified organism
J18.8N/AN/AOther pneumonia, unspecified organism
J18.9N/AN/APneumonia, unspecified organism
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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