Part B News PQRI series: Quality measure breakdown

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article summarizes a set of Physician Quality Reporting Initiative quality measures relevant to family practice and internal medicine. It is useful for clinicians, coders, and billing staff who need a broad view of the measure categories, the specialties and patient groups involved, and the code sets referenced for reporting under the CMS framework in effect at the time.

Why This Topic Matters

The page helps readers quickly determine whether the premium content covers the quality measures, specialties, and code families they need to review for PQRI-related reporting.

Article Sections

  1. PQRI quality measure chart for family practice/internal medicine

    Overview of the reporting chart and how the measures are organized for specialty-based quality reporting. Introduces the general structure of the tables and the CMS update context.

  2. Diabetes, cardiovascular, and fall-risk measures

    Measures covering common chronic disease management and screening topics, including diabetes-related monitoring, blood pressure control, heart failure, coronary artery disease, and fall-risk screening.

  3. Acute care, stroke, and ESRD measures

    Hospital and emergency-related quality measures, including myocardial infarction, stroke and rehabilitation topics, prophylactic antibiotics, and end-stage renal disease monitoring.

  4. Bone health, medication management, and care planning

    Measures addressing osteoporosis care, medication reconciliation after discharge, advance care planning, and urinary incontinence assessment and follow-up.

  5. Pulmonary, digestive, mental health, and pediatric measures

    Measures related to COPD, asthma, GERD, depression, and selected pediatric respiratory/infectious conditions. Covers the general reporting categories and associated coding groupings referenced in the chart.

What You Will Learn

  • How the article organizes PQRI measures by condition and patient population
  • Which broad clinical topics are included for family practice and internal medicine
  • What general code sets are referenced for quality reporting in the chart
  • Which specialty and care settings are represented across the measures
  • How the article frames CMS-era reporting guidance at a high level

Who Should Read This

  • Medical coders
  • Physician billing staff
  • Quality reporting staff
  • Family practice clinicians
  • Internal medicine clinicians

Codes Discussed

Code Ranges Discussed

  • ICD-9: 250.00-250.93
  • ICD-9: 648.00-648.04
  • CPT: 97802-97804
  • CPT: 99201-99205
  • CPT: 99211-99215
  • CPT: 402.01, 402.11, 402.91
  • CPT: 404.01, 404.03, 404.11, 404.13, 404.91, 404.93
  • ICD-9: 428.20-428.23
  • ICD-9: 428.30-428.33
  • ICD-9: 428.40-428.43
  • ICD-9: 414.00-414.07
  • ICD-9: 410.00-410.92
  • ICD-9: 411.0-411.89
  • ICD-9: 413.0-413.9
  • CPT: 99218-99236
  • CPT: 97001-97004
  • ICD-9: 431
  • ICD-9: 433.01
  • ICD-9: 433.11
  • ICD-9: 433.21
  • ICD-9: 433.31
  • ICD-9: 433.81
  • ICD-9: 433.91
  • ICD-9: 434.01
  • ICD-9: 434.11
  • ICD-9: 434.91
  • ICD-9: 435.0-435.3
  • ICD-9: 435.8-435.9
  • ICD-9: 585.6
  • CPT: G0314-G0319
  • CPT: 99238-99239
  • CPT: 99241-99245
  • ICD-9: 491.20-491.22
  • ICD-9: 493-493.02
  • ICD-9: 493.1-493.12
  • ICD-9: 493.2-493.22
  • ICD-9: 493.81-493.82
  • ICD-9: 493.00-493.02
  • ICD-9: 493.10-493.12
  • ICD-9: 493.20-493.22
  • ICD-9: 530.10-530.12
  • ICD-9: 296.20-296.24
  • ICD-9: 460
  • ICD-9: 465.8-465.9
  • ICD-9: 99324-99328
  • ICD-9: 99334-99337
  • ICD-9: 99341-99345
  • ICD-9: 99347-99350

Modifiers Discussed


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