CORE
Hypertension: Blood Pressure Measurement (NQF 0013) (CORE)
Definition: Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure recorded. Diagnosis - Hypertension ICD-9 Definition 401.0 Malignant Essential Hypertension 401.1 Benign Essential Hypertension 401.9 Unspecified Essential Hypertension 402.00 Malignant Hypertensive Heart Disease Without Heart Failure 402.01 Malignant Hypertensive Heart Disease With Heart Failure 402.10 Benign Hypertensive Heart Disease Without Heart Failure 402.11 Benign Hypertensive Heart Disease With Heart Failure 402.90 Unspecified Hypertensive Heart Disease Without Heart Failure 402.91 Unspecified Hypertensive Heart Disease With Heart Failure 403.00 Hypertensive Chronic Kidney Disease, Malignant, With Chronic Kidney Disease Stage I (One) Through Stage IV (Four), Or Unspecified 403.01 Hypertensive Chronic Kidney Disease, Malignant, With Chronic Kidney Disease Stage V (Five) Or End Stage Renal Disease 403.10 Hypertensive Chronic Kidney Disease, Benign, With Chronic Kidney Disease Stage I (One) Through Stage IV (Four), Or Unspecified 403.11 Hypertensive Chronic Kidney Disease, Benign, With Chronic Kidney Disease Stage V (Five) Or End Stage Renal Disease 403.90 Hypertensive Chronic Kidney Disease, Unspecified, With Chronic Kidney Disease Stage I (One) Through Stage IV (Four), Or Unspecified 403.91 Hypertensive Chronic Kidney Disease, Unspecified, With Chronic Kidney Disease Stage V (Five) Or End Stage Renal Disease 404.00 Hypertensive Heart And Chronic Kidney Disease, Malignant, Without Heart Failure And With Chronic Kidney Disease Stage I (One) Through Stage IV (Four), Or Unspecified 404.01 Hypertensive Heart And Chronic Kidney Disease, Malignant, With Heart Failure And With Chronic Kidney Disease Stage I (One) Through Stage IV (Four), Or Unspecified 404.02 Hypertensive Heart And Chronic Kidney Disease, Malignant, Without Heart Failure And With Chronic Kidney Disease Stage V (Five) Or End Stage Renal Disease 404.03 Hypertensive Heart And Chronic Kidney Disease, Malignant, With Heart Failure And With Chronic Kidney Disease Stage V (Five) Or End Stage Renal Disease 404.10 Hypertensive Heart And Chronic Kidney Disease, Benign, Without Heart Failure And With Chronic Kidney Disease Stage I (One) Through Stage IV (Four), Or Unspecified 404.11 Hypertensive Heart And Chronic Kidney Disease, Benign, With Heart Failure Or 1
404.12 404.13 404.90
404.91
404.92
404.93
And With Chronic Kidney Disease Stage I (One) Through Stage IV (Four), Or Unspecified Hypertensive Heart And Chronic Kidney Disease, Benign, Without Heart Failure And With Chronic Kidney Disease Stage V (Five) Or End Stage Renal Disease Hypertensive Heart And Chronic Kidney Disease, Benign, With Heart Failure And Chronic Kidney Disease Stage V (Five) Or End Stage Renal Disease Hypertensive Heart And Chronic Kidney Disease, Unspecified, Without Heart Failure And With Chronic Kidney Disease Stage I (One) Through Stage IV (Four), Or Unspecified Hypertensive Heart And Chronic Kidney Disease, Unspecified, With Heart Failure And With Chronic Kidney Disease Stage I (One) Through Stage IV (Four), Or Unspecified Hypertensive Heart And Chronic Kidney Disease, Unspecified, Without Heart Failure And With Chronic Kidney Disease Stage V (Five) Or End Stage Renal Disease Hypertensive Heart And Chronic Kidney Disease, Unspecified, With Heart Failure And Chronic Kidney Disease Stage V (Five) Or End Stage Renal Disease
2
Preventative Care and Screening Measure Pair: Tobacco Use Assessment and Tobacco Cessation Intervention (NQF 0028) (CORE)
Description: Percentage of patients aged 18 years or older who have been seen for at least 2 office visits, who were queried about tobacco use one or more times within 24 months. Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months who and have been seen for at least 2 office visits, who received cessation intervention. Procedures - Enter in SOAP note or past medical History CPT Description 99406 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES 99407 TOBACCO USE CESSATION INTENSIVE >10 MINUTES Advised to quit and given medication - Enter in procedures in SOAP note 4001F TOBACCO USE CESSATION IVNTJ PHARMACOLOGIC THER Medication RxNorm Descripition 105075 16 HR Nicotine 0.313 MG/HR Transdermal Patch 198029 24 HR Nicotine 0.583 MG/HR Transdermal Patch 198030 24 HR Nicotine 0.875 MG/HR Transdermal Patch 198031 24 HR Nicotine 0.292 MG/HR Transdermal Patch 198406 16 HR Nicotine 0.625 MG/HR Transdermal Patch 198407 16 HR Nicotine 0.938 MG/HR Transdermal Patch 227177 Nicotine 2 MG Sublingual Tablet 250983 Nicotine 4 MG/ACTUAT Inhalant Solution 311975 Nicotine 4 MG Chewing Gum 314119 Nicotine 2 MG Chewing Gum 359817 Nicotine 2 MG Lozenge 359818 Nicotine 4 MG Lozenge 388082 Nicotine 1 MG Lozenge Encounters: Health and behavior assessment CPT 96150 96152 Descripition HLTH&BEHAVIOR ASSMT EA 15 MIN F2F W/PT 1ST ASSMT HLTH&BEHAVIOR IVNTJ EA 15 MIN F2F INDIV
Psychiatric & psychologic CPT 90801 90802 90804 90805 90806 90807 90808 90809 90810 90811 90812 90813 90814 90815 90845 90862 Descripition PSYC DX INTERVIEW XM INTERACTIVE PSYCHIATRIC DX EXAM, USING PLAY EQUIPMENT/PX DEVICES/LANGUAGE INTERPRETER/OTHER IPI-OB-M/S OFFICE 20-30 MIN PSYTX, OFF, 20-30 MIN W/E&M PSYTX, OFF, 45-50 MIN IPI-OB-M/S OFFICE 45-50 MIN MEDICAL E/M IPI-OB-M/S OFFICE 75-80 MIN IPI-OB-M/S OFFICE 75-80 MIN MEDICAL E/M INDIV PSYCTX IA 20-30 MIN INDIV PSYCTX IA 20-30 MIN MEDICAL E/M INDIV PSYCTX IA 45-50 MIN INDIV PSYCTX IA 45-50 MIN MEDICAL E/M INDIV PSYCTX IA 45-50 MIN MEDICAL E/M INDIV PSYCTX IA 75-80 MIN MEDICAL E/M PSYCHOALYS PHARMACOLOGIC MGMT MIN MEDICAL PSYCTX
Individual counseling CPT 99401 99401 99402 99403 99404 Descripition PREVENTIVE MEDICINE COUNSELING, INDIV; 15 MIN PREVENTIVE MEDICINE COUNSELING, INDIV; 15 MIN PREVENTIVE MEDICINE COUNSELING, INDIV; 30 MIN PREVENTIVE MEDICINE COUNSELING, INDIV; 45 MIN 'PREV MED CNSL INDIV SPX 60 MIN
Group counseling CPT 99411 99411 99412 Descripition PREV MED CNSL GRP SPX 30 MIN PREV MED CNSL GRP SPX 30 MIN PREV MED CNSL GRP SPX 60 MIN
4
Other preventive medical services quality CPT 99420 99420 99429 Descripition ADMN&INTERPJ HLTH RISK ASSMT INSTRUMENT ADMN&INTERPJ HLTH RISK ASSMT INSTRUMENT UNLIS PREV MED SVC
Advised to quit and given Counseling - Enter in SOAP note or past medical history CPT Descripition 4000F- TOBACCO USE CESSATION IVNTJ COUNSELING Active users of tobacco products 171055003 Smoking in pregnancy education 185792005 Stop smoking monitoring first letter 185793000 Stop smoking monitoring second letter 185794006 Stop smoking monitoring third letter 185795007 Stop smoking monitoring verbal invite 185796008 Stop smoking monitoring telephone invite 225323000 Smoking cessation education 225324006 Smoking effects education 310429001 Smoking monitoring invitation 315232003 Referral to stop-smoking clinic 384742004 Smoking cessation assistance
5
Adult Weight Screening and Follow-up (NQF 0421) (CORE)
Description: Of the Medicare population, 37% are overweight and 18% are obese. The likelihood of being asked about diet or physical activity during a routine checkup declined with age (Real-Time and Prospective Rule). Diagnosis Active – pregnancy ICD-9-CM Description 630…633 Ectopic and Molar Pregnancy 634…639 Other Pregnancy with Abortive Outcome 640…649 Complications Mainly Related to Pregnancy Normal Delivery and other Indications for care in Pregnancy, Labor, and 650…659 Delivery 660…669 Complications Occurring Mainly in the Course of Labor and Delivery 670…677 Complications of the Puerperium V22.0 Supervision Of Normal First Pregnancy V22.1 Supervision Of Other Normal Pregnancy V22.2 Pregnant State, Incidental V23.0 Supervision Of High-risk Pregnancy With History Of Infertility V23.1 Supervision Of High-risk Pregnancy With History Of Trophoblastic Disease V23.2 Supervision Of High-risk Pregnancy With History Of Abortion V23.3 Supervision Of High-risk Pregnancy With Grand Multiparity V23.41 Supervision Of High-risk Pregnancy With history of pre-term labor V23.49 Supervision Of High-risk Pregnancy With other poor obstetric history V23.5 Supervision Of High-risk Pregnancy With Other Poor Reproductive History V23.7 Supervision Of High-risk Pregnancy With Insufficient Prenatal Care V23.81 Elderly primigravida V23.82 Elderly multigravida V23.83 Young primigravida V23.84 Young multigravida V23.85 Pregnancy resulting from assisted reproductive technology V23.86 Pregnancy with history of in utero procedure during previous pregnancy V23.89 Other high-risk pregnancy V23.9 Supervision of unspecified high-risk pregnancy V28.0 Encounter for antenatal screening for chromosomal anomalies by amniocentesis of mother V28.1 Encounter for antenatal screening for raised alpha-fetoprotein levels in amniotic fluid of mother V28.2 Encounter for other antenatal screening based on amniocentesis of mother V28.3 Encounter for routine antenatal screening for malformation using ultrasonics of mother V28.4 Encounter for antenatal screening for fetal growth retardation using ultrasonics of mother 6
V28.5 V28.6 V28.81 V28.82 V28.89 V28.9
Encounter for antenatal screening for isoimmunization of mother Encounter for antenatal screening for Streptococcus B of mother Encounter for fetal anatomic survey Encounter for screening for risk of pre-term labor Other specified antenatal screening Encounter for unspecified antenatal screening of mother
Care Plan - follow-up plan_BMI management CPT Description 43644 LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y <150 CM 43645 LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ 43770 LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE 43771 LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE 43772 LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE 43773 LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE 43774 LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE &PORT 43842 GSTR RSTCV W/O BYP VER-BANDED GSTP Gastric restrictive procedure, without gastric bypass, for morbid obesity; other 43843 than vertical-banded gastroplasty 43845 GSTR RSTCV W/PRTL GSTRCT 50-100 CM 43846 GSTR RSTCV W/BYP W/SHORT LIMB 150 CM/< 43847 GSTR RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ 43848 REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE 97804 MED NUTR THER GRP2/> INDIV EA 30 MIN 98961 EDUCAJ&TRAINJ F/PT SELF-MGMT BY NONPHYS 2-4 PT 98962 EDUCAJ&TRAINJ F/PT SELF-MGMT BY NONPHYS 5-8 PTS 99078 PHYS EDUCATIONAL SVCS RENDERED PTS GRP SETTING Care Plan - follow-up plan_BMI management ICD-9CM Description V65.3 Dietary surveillance and counseling Care Plan - follow-up plan_BMI management SNOMEDCT Description 169411000 Vitamin/diet support therapy 170795002 Follow-up obesity assessment 225171007 Weight and body mass assessment procedure 268523001 Target weight discussed 275919002 Weight loss advised 305849009 Seen by dietetics - service 307818003 Weight monitoring 7
401003006 Weight loss from baseline weight
Communication provider to provider - dietary consultation order SNOMEDCT Description 103699006 Patient referral to dietitian 306163007 Referral to dietetics service 408289007 Refer to weight management program Patient characteristic – terminal illness SNOMEDCT Description 162607003 Terminal illness - early stage 162608008 Terminal illness - late stage 300936002 Terminal disease Encounter – encounter_outpatient_CPT_with clinician CPT Description 90801 PSYC DX INTERVIEW XM 90802 IA PSYC DX INTERVIEW XM W/PLAY 90804 IPI-OB-M/S OFFICE 20-30 MIN 90805 IPI-OB-M/S OFFICE 20-30 MIN MEDICAL E/M 90806 IPI-OB-M/S OFFICE 45-50 MIN 90807 IPI-OB-M/S OFFICE 45-50 MIN MEDICAL E/M 90808 IPI-OB-M/S OFFICE 75-80 MIN 90809 IPI-OB-M/S OFFICE 75-80 MIN MEDICAL E/M 97001 PHYSICAL THER EVAL 97003 OCCUPATIONAL THER EVAL 97802 MED NUTR THER 1ST ASSMT&IVNTJ INDIV EA 15 MIN 97803 MED NUTR THER RE-ASSMT&IVNTJ INDIV EA 15 MIN 98960 EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT 99201 OFFICE OUTPT NEW 10 MIN 99202 OFFICE OUTPT NEW 20 MINUTES 99203 OFFICE OUTPT NEW 30 MIN 99204 OFFICE OUTPT NEW 45 MIN 99205 OFFICE OUTPT NEW 60 MIN 99211 OFFICE O/P EST 5 MIN 99212 OFFICE OUTPT EST 10 MIN 99213 OFFICE OUTPT EST15 MIN 99214 OFFICE OUTPT EST 25 MIN 99215 OFFICE OUTPT EST 40 MIN 99324 DOM/R-HOME LW SEVERITY 8
DOM/R-HOME E/M NEW PT MOD SEVERITY DOM/R-HOME E/M NEW PT MOD HI SEVERITY DOM/R-HOME E/M NEW PT HI SEVERITY DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM DOM/R-HOME E/M EST PT SELF-LMTD/MINOR DOM/R-HOME E/M EST PT LW MOD SEVERITY DOM/R-HOME E/M EST PT MOD HI SEVERITY DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM HOME VST NEW PT LOW SEVERITY HOME VST NEW PT MOD SEVERITY HOME VST NEW PT MOD TO HI SEVERITY HOME VST NEW PT HI SEVERITY HOME VST NEW PT UNSTABLE/SIGNIFICANT NEW PROBLEM HOME VST EST PT SELF LIMITED/MINOR HOME VST EST PT LOW TO MOD SEVERITY HOME VST EST PT MOD TO HI SEVERITY HOME VST EST PT UNSTABLE/SIGNIFICANT NEW PROBLEM
9
ALTERNATE CORE
Weight Assessment and Counseling for Children and Adolescents (NQF 0024) (Alternate CORE)
Description: The percentage of patients 2‐17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year. Active diagnosis of pregnancy ICD-9 Descripition 630...633 Ectopic and Molar Pregnancy 634...639 Other Pregnancy with Abortive Outcome 640...649 Complications Mainly Related to Pregnancy Normal Delivery and other Indications for care in Pregnancy, Labor, and 650...659 Delivery 660...669 Complications Occurring Mainly in the Course of Labor and Delivery 670...677 Complications of the Puerperium V22.0 Supervision Of Normal First Pregnancy V22.1 V22.2 V23.0 V23.1 V23.2 V23.3 V23.41 V23.49 V23.5 V23.7 V23.81 V23.82 V23.83 V23.84 V23.85 V23.86 V23.89 V23.9 V28.0 V28.1 Supervision Of Other Normal Pregnancy Pregnant State, Incidental Supervision Of High-risk Pregnancy With History Of Infertility Supervision Of High-risk Pregnancy With History Of Trophoblastic Disease Supervision Of High-risk Pregnancy With History Of Abortion Supervision Of High-risk Pregnancy With Grand Multiparity Supervision Of High-risk Pregnancy With history of pre-term labor Supervision Of High-risk Pregnancy With other poor obstetric history Supervision Of High-risk Pregnancy With Other Poor Reproductive History Supervision Of High-risk Pregnancy With Insufficient Prenatal Care Elderly primigravida Elderly multigravida Young primigravida Young multigravida Pregnancy resulting from assisted reproductive technology Pregnancy with history of in utero procedure during previous pregnancy Other high-risk pregnancy Supervision of unspecified high-risk pregnancy Encounter for antenatal screening for chromosomal anomalies by amniocentesis of mother Encounter for antenatal screening for raised alpha-fetoprotein levels in amniotic fluid of mother
Encounter for other antenatal screening based on amniocentesis of mother Encounter for routine antenatal screening for malformation using ultrasonics of mother Encounter for antenatal screening for fetal growth retardation using ultrasonics of mother Encounter for antenatal screening for isoimmunization of mother Encounter for antenatal screening for Streptococcus B of mother Encounter for fetal anatomic survey Encounter for screening for risk of pre-term labor Other specified antenatal screening Encounter for unspecified antenatal screening of mother
BMI measurements – enter height and weight in vitals Counseling for nutrition- CPT codes- ICD-9 code - Enter in procedures 97802 MED NUTR THER 1ST ASSMT&IVNTJ INDIV EA 15 MIN 97803 MED NUTR THER RE-ASSMT&IVNTJ INDIV EA 15 MIN 97804 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes V65.3 Dietary surveillance and counseling Counseling for physicial activity- Enter in procedures ICD-9 Descripition V65.41 Exercise counseling OB/GYN Encounter- Enter in past medical history ICD9 Description V24 Postpartum care and examination V25 Encounter for contraceptive management V26 Procreative management V27 Outcome of delivery V28 Encounter for antenatal screening of mother V45.5 Presence of contraceptive device V61.5 Multiparity V61.6 Illegitimacy or illegitimate pregnancy V61.7 Other unwanted pregnancy V69.2 High-risk sexual behavior V72.3 Special investigations and examinations - Gynecological examination V72.4 Pregnancy examination or test
11
Childhood Immunization Status (NQF 0038) (Alternate CORE)
Description: The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates. Diagnosis of encephalopathy or progressive neurological disorder ICD-9 Description 323.51 Encephalitis and encephalomyelitis following immunization procedures SNOMED 230363006 Progressive neuronal degeneration of childhood 292925004 Streptomycin adverse reaction 292927007 Neomycin adverse reaction 292992006 Polymyxin B adverse reaction Diagnosis (active or resolved) of measles ICD-9 Description 55 Measles Diagnosis of HIV, immunodeficiency, multiple myeloma, leukemia, or cancer of lymphoreticular or histiocytic tissue ICD-9 42 V08 201 202 203 200 202 204 205 206 207 208 279 203 Description Human immunodeficiency virus [HIV] disease Asymptomatic human immunodeficiency virus [HIV] infection status Hodgkin's disease Other malignant neoplasms of lymphoid and histiocytic tissue Multiple myeloma and immunoproliferative neoplasms Lymphosarcoma and reticulosarcoma and other specified malignant tumors of lymphatic tissue Other malignant neoplasms of lymphoid and histiocytic tissue Lymphoid leukemia Myeloid leukemia Monocytic leukemia Other specified leukemia Leukemia of unspecified cell type Disorders involving the immune mechanism Multiple myeloma and immunoproliferative neoplasms
0.5 ML influenza A-California-7-2009-(H1N1)v-like virus vaccine 0.03 MG/ML Prefilled Syringe 0.2 ML influenza A-California-7-2009-(H1N1)v-like virus vaccine 158000000 UNT/ML Nasal Spray
19
Preventative Care and Screening: Influenza Immunization for Patients >50 Years Old (NQF 0041) (Alternate CORE)
Description: Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February). Influenza Immunization – Add Immunization to Administered Meds or as Reported Med RxNorm Description 0.5 ML Influenza Virus Vaccine, Inactivated A-Brisbane-59-2007, IVR-148 (H1N1) strain 0.03 MG/ML / Influenza Virus Vaccine, Inactivated A-Uruguay716-2007, NYMC X-175C (H3N2) strain 0.03 MG/ML / Influenza Virus Vaccine, Inactivated B-Brisbane-60-2008 strain 0.03 MG/ML Prefilled 857924 Syringe Influenza Virus Vaccine, Inactivated A-Brisbane-59-2007, IVR-148 (H1N1) strain 0.03 MG/ML / Influenza Virus Vaccine, Inactivated A-Uruguay-7162007, NYMC X-175C (H3N2) strain 0.03 MG/ML / Influenza Virus Vaccine, 857942 Inactivated B-Brisbane-60-2008 strain 0.03 MG/ML Injectable Suspension 0.25 ML Influenza Virus Vaccine, Inactivated A-Brisbane-59-2007, IVR-148 (H1N1) strain 0.03 MG/ML / Influenza Virus Vaccine, Inactivated A-Uruguay716-2007, NYMC X-175C (H3N2) strain 0.03 MG/ML / Influenza Virus Vaccine, Inactivated B-Brisbane-60-2008 strain 0.03 MG/ML Prefilled 857965 Syringe Encounter Nursing Facility CPT 99304 99305 99306 99307 99308 99309 99310 Description 1ST NF CARE PR D E/M LW SEVERITY 1ST NF CARE PR D E/M MOD SEVERITY 1ST NF CARE PR D E/M HI SEVERITY SBSQ NF CARE PR D E/M STABLE SBSQ NF CARE PR D E/M MINOR COMPLCTJ SBSQ NF CARE PR D E/M NEW PROBLEM SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM
Encounter Nursing Discharge CPT 99315 99316 Description NF DSCHRG D MGMT 30 MIN/< NF DSCHRG D MGMT > 30 MIN
Encounter Prev Med 40 and Older CPT 99386 99387 Description 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 40-64YRS 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 65YRS&>
20
99395 99396 99397
PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, EST PT; 18-39 YR PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, EST PT; 40-64 YR PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE E&M W/HX/EXAM, EST PT; 65+ YR
Encounter Prev Med-Individual counseling CPT 99401 99402 99403 99404 Description PREVENTIVE MEDICINE COUNSELING, INDIV; 15 MIN PREVENTIVE MEDICINE COUNSELING, INDIV; 30 MIN PREVENTIVE MEDICINE COUNSELING, INDIV; 45 MIN 'PREV MED CNSL INDIV SPX 60 MIN
Encounter Prev Med Group Counseling CPT 99411 99412 Description PREV MED CNSL GRP SPX 30 MIN PREV MED CNSL GRP SPX 60 MIN
Encounter Prev Med Other Services CPT 99420 99429 Description ADMN&INTERPJ HLTH RISK ASSMT INSTRUMENT UNLIS PREV MED SVC
21
ADDITIONAL MEASURES
Asthma Assessment (NQF 0001) (Additional Measure - MENU)
Description: Percentage of patients aged 5 through 40 years with a diagnosis of asthma and who have been seen for at least 2 office visits, which were evaluated during at least one office visit within 12 months for the frequency (numeric) of daytime and nocturnal asthma symptoms. Diagnosis - Asthma ICD9 Description 493 Asthma 493.01 Extrinsic asthma with status asthmaticus 493.02 Extrinsic asthma, with (acute) exacerbation 493.1 Intrinsic asthma 493.11 Intrinsic asthma with status asthmaticus 493.12 Intrinsic asthma, with (acute) exacerbation 493.2 Chronic obstructive asthma 493.21 Chronic obstructive asthma, with status asthmaticus 493.22 Chronic obstructive asthma, with (acute) exacerbation 493.81 Exercise induced bronchospasm 493.82 Cough variant asthma 493.9 Asthma, unspecified 493.91 Asthma, unspecified type, with status asthmaticus 493.92 Asthma, unspecified with (acute) exacerbation Daytime and nighttime symptoms of asthma assessed and quantified SNO-MED Description 370202007 Asthma causes daytime symptoms 1 to 2 times per month 370203002 Asthma causes daytime symptoms 1 to 2 times per week 370208006 Asthma never causes daytime symptoms 170635006 Asthma not disturbing sleep 170636007 Asthma never disturbs sleep 370205009 Asthma causes night symptoms 1 to 2 times per month Active daytime and nighttime symptoms of asthma in quantifiable form SNO-MED Description 370204008 Asthma causes daytime symptoms most days 373899003 Asthma daytime symptoms 170631002 Asthma disturbing sleep 170632009 Asthma causing night waking 170633004 Asthma disturbs sleep weekly 170634005 Asthma disturbs sleep frequently 395022009 Asthma night-time symptoms Evidence of asthma symptom assessment tool SNO-MED Description 401011001 Peak expiratory flow rate monitoring using diary 22
Testing for Children with Pharyngitis (NQF 0002) (Additional Measure MENU)
Description: This measure is important because it requires initial antigen screening to ensure accurate diagnosis and promotes judicious use of antibiotics and reduction of antibiotic use. (Retrospective Rule).
Streptococcus pyogenes [Presence] in Throat by 11268-0 Organism specific culture Streptococcus pyogenes [Presence] in Unspecified 17656-0 specimen by Organism specific culture 18481-2 Streptococcus pyogenes Ag [Presence] in Throat Streptococcus pyogenes Ag [Presence] in 31971-5 Unspecified specimen Streptococcus pyogenes DNA [Identifier] in Unspecified specimen by Probe & target 49610-9 amplification method Streptococcus pyogenes rRNA [Presence] in 5036-9 Unspecified specimen by DNA probe
23
626-2 Bacteria identified in Throat by Culture Streptococcus pyogenes Ag [Presence] in Throat by 6556-5 Immunoassay Streptococcus pyogenes Ag [Presence] in 6558-1 Unspecified specimen by Immunoassay Streptococcus pyogenes Ag [Presence] in 6559-9 Unspecified specimen by Immunofluorescence
Medication - Pharyngitis antibiotics active, ordered, or dispensed (reported med does not qualify) RXNorm Description
Encounters- ED - Enter in Past Medical History CPT 99281 99282 99283 99284 99285 Description EMER DEPT SELF LIMITED/MINOR EMER DEPT LOW TO MODERATE SEVERITY EMER DEPT MODERATE SEVERITY EMER DEPT HI SEVERITY&URGENT EVAL EMER DEPT HIGH SEVERITY&THREAT FUNCJ
43
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation (b) Engagement (NQF 0004) (Additional Measure MENU)
Description: This measure is designed to ensure that treatment is initiated once the need has been identified and will permit comparison of effectiveness in initiating care (Retrospective Rule). Active diagnosis of alcohol or drug dependence ICD9 Description 291 Alcohol-induced mental disorders 291.00 no result 291.1 Alcohol-induced persisting amnestic disorder 291.2 Alcohol-induced persisting dementia 291.3 Alcohol-induced psychotic disorder with hallucinations 291.4 Idiosyncratic alcohol intoxication 291.5 Alcohol-induced psychotic disorder with delusions 291.8 Other specified alcohol-induced mental disorders 291.81 Alcohol withdrawal 291.82 Alcohol induced sleep disorders 291.89 Other specified alcohol-induced mental disorders 291.9 Unspecified alcohol-induced mental disorders 292 Drug-induced mental disorders 292.0 Drug withdrawal 292.11 Drug-induced psychotic disorder with delusions 292.12 Drug-induced psychotic disorder with hallucinations 292.2 Pathological drug intoxication 292.8 Other specified drug-induced mental disorders 292.81 Drug-induced delirium 292.82 Drug-induced persisting dementia 292.83 Drug-induced persisting amnestic disorder 292.84 Drug-induced mood disorder 292.85 Drug induced sleep disorders 292.89 Other specified drug-induced mental disorders 292.9 Unspecified drug-induced mental disorder 303.00 Acute alcoholic intoxication in alcoholism, unspecified drinking behavior 303.01 Acute alcoholic intoxication in alcoholism, continuous drinking behavior 303.02 Acute alcoholic intoxication in alcoholism, episodic drinking behavior 303.90 Other and unspecified alcohol dependence, unspecified drinking behavior 303.91 Other and unspecified alcohol dependence, continuous drinking behavior 303.92 Other and unspecified alcohol dependence, episodic drinking behavior 304.00 Opioid type dependence, unspecified use 304.01 Opioid type dependence, continuous use 44
Opioid type dependence, episodic use Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Cocaine dependence, unspecified use Cocaine dependence, continuous use Cocaine dependence, episodic use Cannabis dependence, unspecified use Cannabis dependence, continuous use Cannabis dependence, episodic use Amphetamine and other psychostimulant dependence, unspecified use Amphetamine and other psychostimulant dependence, continuous use Amphetamine and other psychostimulant dependence, episodic use Hallucinogen dependence, unspecified use Hallucinogen dependence, continuous use Hallucinogen dependence, episodic use Other specified drug dependence, unspecified use Other specified drug dependence, continuous use Other specified drug dependence, episodic use Combinations of opioid type drug with any other drug dependence, unspecified use Combinations of opioid type drug with any other drug dependence, continuous use Combinations of opioid type drug with any other drug dependence, episodic use Combinations of drug dependence excluding opioid type drug, unspecified use Combinations of drug dependence excluding opioid type drug, continuous use Combinations of drug dependence excluding opioid type drug, episodic use Unspecified drug dependence, unspecified use Unspecified drug dependence, continuous use Unspecified drug dependence, episodic use Alcohol abuse, unspecified drinking behavior Alcohol abuse, continuous drinking behavior Alcohol abuse, episodic drinking behavior Cannabis abuse, unspecified use Cannabis abuse, continuous use Cannabis abuse, episodic use Hallucinogen abuse, unspecified use Hallucinogen abuse, continuous use Hallucinogen abuse, episodic use Sedative, hypnotic or anxiolytic abuse, unspecified Sedative, hypnotic or anxiolytic abuse, continuous
Sedative, hypnotic or anxiolytic abuse, episodic Opioid abuse, unspecified use Opioid abuse, continuous use Opioid abuse, episodic use Cocaine abuse, unspecified use Cocaine abuse, continuous use Cocaine abuse, episodic use Amphetamine or related acting sympathomimetic abuse, unspecified use Amphetamine or related acting sympathomimetic abuse, continuous use Amphetamine or related acting sympathomimetic abuse, episodic use Antidepressant type abuse, unspecified use Antidepressant type abuse, continuous use Antidepressant type abuse, episodic use Other, mixed, or unspecified drug abuse, unspecified use Other, mixed, or unspecified drug abuse, continuous use Other, mixed, or unspecified drug abuse, episodic use Alcoholic gastritis Alcoholic gastritis, without mention of hemorrhage Alcoholic gastritis, with hemorrhage Acute alcoholic hepatitis
Procedure performed for alcohol, drug rehab and detox interventions SNOMEDCT Description 20093000 Alcohol rehabilitation and detoxification 23915005 Combined alcohol and drug rehabilitation and detoxification 35637008 Alcohol rehabilitation 52052004 Rehabilitation therapy 56876005 Drug rehabilitation and detoxification 62213004 Combined alcohol and drug rehabilitation 78092008 Drug rehabilitation Procedure performed for detoxification interventions SNOMEDCT Description 67516001 Detoxication therapy Encounter – acute inpatient CPT Description 99221 1ST HOSP CARE PR D 30 MIN 99222 1ST HOSP CARE PR D 50 MIN 99223 1ST HOSP CARE PR D 70 MIN 99231 SBSQ HOSP CARE PR D 15 MIN 99232 SBSQ HOSP CARE PR D 25 MIN 99233 SBSQ HOSP CARE PR D 35 MIN 46
99238 99239 99251 99252 99253 99254 99255 99291
HOSP DSCHRG D MGMT 30 MIN/< HOSP DSCHRG D MGMT > 30 MIN 1ST INPT CONSLTJ 20 MIN 1ST INPT CONSLTJ 40 MIN 1ST INPT CONSLTJ 55 MIN 1ST INPT CONSLTJ 80 MIN 1ST INPT CONSLTJ 110 MIN CC E/M CRITICALLY ILL/INJURED 1ST 30-74 MIN
Encounter – ED CPT Description 99281 EMER DEPT SELF LIMITED/MINOR 99282 EMER DEPT LOW TO MODERATE SEVERITY 99283 EMER DEPT MODERATE SEVERITY 99284 EMER DEPT HI SEVERITY&URGENT EVAL 99285 EMER DEPT HIGH SEVERITY&THREAT FUNCJ Encounter – non-acute inpatient CPT Description 99304 1ST NF CARE PR D E/M LW SEVERITY 99305 1ST NF CARE PR D E/M MOD SEVERITY 99306 1ST NF CARE PR D E/M HI SEVERITY 99307 SBSQ NF CARE PR D E/M STABLE 99308 SBSQ NF CARE PR D E/M MINOR COMPLCTJ 99309 SBSQ NF CARE PR D E/M NEW PROBLEM 99310 SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM 99315 NF DSCHRG D MGMT 30 MIN/< 99316 NF DSCHRG D MGMT > 30 MIN 99318 E/M PT INVG ANNUAL NF ASSMT 99324 DOM/R-HOME LW SEVERITY 99325 DOM/R-HOME E/M NEW PT MOD SEVERITY 99326 DOM/R-HOME E/M NEW PT MOD HI SEVERITY 99327 DOM/R-HOME E/M NEW PT HI SEVERITY 99328 DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM 99334 DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 99335 DOM/R-HOME E/M EST PT LW MOD SEVERITY 99337 DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM Encounter – outpatient BH CPT Description 90804 IPI-OB-M/S OFFICE 20-30 MIN 90805 IPI-OB-M/S OFFICE 20-30 MIN MEDICAL E/M 90806 IPI-OB-M/S OFFICE 45-50 MIN 90807 IPI-OB-M/S OFFICE 45-50 MIN MEDICAL E/M 90808 IPI-OB-M/S OFFICE 75-80 MIN 47
IPI-OB-M/S OFFICE 75-80 MIN MEDICAL E/M INDIV PSYCTX IA 20-30 MIN INDIV PSYCTX IA 20-30 MIN MEDICAL E/M INDIV PSYCTX IA 45-50 MIN INDIV PSYCTX IA 45-50 MIN MEDICAL E/M INDIV PSYCTX IA 75-80 MIN INDIV PSYCTX IA 75-80 MIN MEDICAL E/M EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS PHYS EDUCATIONAL SVCS RENDERED PTS GRP SETTING OFFICE OUTPT NEW 10 MIN OFFICE OUTPT NEW 20 MINUTES OFFICE OUTPT NEW 30 MIN OFFICE OUTPT NEW 45 MIN OFFICE OUTPT NEW 60 MIN OFFICE O/P EST 5 MIN OFFICE OUTPT EST 10 MIN OFFICE OUTPT EST15 MIN OFFICE OUTPT EST 25 MIN OFFICE OUTPT EST 40 MIN OBS CARE DSCHRG D MGMT 1ST OBS CARE PR D LOW SEVERITY 1ST OBS CARE PR D MODERATE SEVERITY 1ST OBS CARE PR D HIGH SEVERITY OFFICE CONSLTJ 15 MIN OFFICE CONSLTJ 30 MIN OFFICE CONSLTJ 40 MIN OFFICE CONSLTJ 60 MIN OFFICE CONSLTJ 80 MIN HOME VST NEW PT LOW SEVERITY HOME VST NEW PT MOD SEVERITY HOME VST NEW PT MOD TO HI SEVERITY HOME VST NEW PT HI SEVERITY HOME VST NEW PT UNSTABLE/SIGNIFICANT NEW PROBLEM HOME VST EST PT SELF LIMITED/MINOR HOME VST EST PT LOW TO MOD SEVERITY HOME VST EST PT MOD TO HI SEVERITY HOME VST EST PT UNSTABLE/SIGNIFICANT NEW PROBLEM 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 12-17 YR 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 18-39YRS 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 40-64YRS 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 65YRS&>
PERIODIC PREVENTIVE MED EST PATIENT AGE 12-17YRS PERIODIC PREVENTIVE MED EST PATIENT AGE 18-39YRS PERIODIC PREVENTIVE MED EST PATIENT AGE 40-64YRS PERIODIC PREVENTIVE MED EST PATIENT AGE 65YRS&> PREV MED CNSL INDIV SPX 15 MIN PREV MED CNSL INDIV SPX 30 MIN PREV MED CNSL INDIV SPX 45 MIN PREV MED CNSL INDIV SPX 60 MIN ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN ALCOHOL/SUBSTANCE SCREEN & INTERVEN >30 MIN PREV MED CNSL GRP SPX 30 MIN PREV MED CNSL GRP SPX 60 MIN HOME VST INDIV FAM/MARRIAGE CNSL
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Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) (NQF 0012) (Additional Measure - MENU)
Description: Percentage of patients, regardless of age, who gave birth during a 12-month period who were screened for HIV infection during the first or second prenatal visit. Active diagnosis of delivery live births ICD9 Description 640…649 Complications Mainly Related to Pregnancy Normal Delivery and other indications for care in Pregnancy, Labor and 650…659 Delivery 660…669 Complications Occurring Mainly in the Course of Labor and Delivery Active or inactive diagnosis of HIV ICD9 Description 042 Human immunodeficiency virus [HIV] disease V08 Asymptomatic human immunodeficiency virus [HIV] infection status Procedure performed for delivery of live births - Enter past medical history CPT Description 59400 OB CARE ANTEPARTUM VAG DLVR&POSTPARTUM 59409 VAG DLVR ONLY 59410 VAG DLVR ONLY POSTPARTUM CARE 59425 ANTEPARTUM CARE ONLY 4-6 VSTS 59426 ANTEPARTUM CARE ONLY 7+ VSTS 59510 OB ANTEPARTUM CARE C DLVR&POSTPARTUM 59514 CESAREAN DELIVERY ONLY 59515 C DLVR ONLY W/POSTPARTUM CARE 59610 OB ANTEPARTUM VAG DLVR&POSTPARTUM AFTER C DLVR 59612 VAG DLVR AFTER C DLVR 59614 VAG DLVR AFTER C DLVR POSTPARTUM CARE 59618 ANTEPARTUM C DLVR&POSTPARTUM FA V AP C DLVER 59620 C DLVR ONLY FA V AP C DLVER 59622 C DLVR ONLY FA V AP C DLVER W/POSTPARTUM CARE Lab test for HIV Screening LOINC Descripition 35437-3 HIV 1 Ab [Presence] in Saliva by Immunoassay 35438-1 HIV 1 Ab [Units/volume] in Saliva by Immunoassay 35439-9 HIV 1 Ab [Presence] in Saliva by Immunoblot (IB) 35440-7 HIV 1 gp160 Ab [Presence] in Saliva by Immunoblot (IB) 35441-5 HIV 1 gp120 Ab [Presence] in Saliva by Immunoblot (IB) 35442-3 HIV 1 p66 Ab [Presence] in Saliva by Immunoblot (IB) 35443-1 HIV 1 p65 Ab [Presence] in Saliva by Immunoblot (IB) 35444-9 HIV 1 p55 Ab [Presence] in Saliva by Immunoblot (IB) 35445-6 HIV 1 p51 Ab [Presence] in Saliva by Immunoblot (IB) 50
HIV 1 gp41 Ab [Presence] in Saliva by Immunoblot (IB) HIV 1 p31 Ab [Presence] in Saliva by Immunoblot (IB) HIV 1 p24 Ab [Presence] in Saliva by Immunoblot (IB) HIV 1 p17 Ab [Presence] in Saliva by Immunoblot (IB) HIV 1 P18 AB:ACNC:PT:SALIVA:ORD:IB HIV 1 gp40 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 p31+p32 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 p40 Ab [Presence] in Serum by Immunoblot (IB) HIV 1+Hepatitis C virus RNA [Presence] in Serum or Plasma from Blood product unit by Probe & target amplification method HIV 1 p24 Ab [Presence] in Serum by Immunoassay HIV 1 gp41 Ab [Presence] in Serum by Immunoassay HIV 1 gp120+gp160 Ab [Presence] in Serum by Immunoassay HIV 1 IgG Ab [Presence] in Serum by Immunoblot (IB) HIV 1+2 IgG Ab [Presence] in Serum by Immunoassay HIV 1 Ab [Units/volume] in Saliva HIV 1 Ab [Presence] in Saliva HIV 1 Ab [Presence] in Capillary blood HIV 1+2 IgM Ab [Units/volume] in Serum by Immunoassay HIV 1 RNA [Log #/volume] in Cerebral spinal fluid by Probe & target amplification method HIV 1 RNA [#/volume] in Cerebral spinal fluid by Probe & target amplification method HIV 1 RNA [#/volume] in Serum or Plasma by Probe with amplification detection limit = 400 copies/mL HIV 1 RNA [Log #/volume] in Serum or Plasma by Probe with amplification detection limit = 2.6 log copies/mL HIV 1 RNA [#/volume] in Serum or Plasma by Probe with amplification detection limit = 75 copies/mL HIV 1 RNA [Log #/volume] in Serum or Plasma by Probe with amplification detection limit = 1.9 log copies/mL HIV 1 p24 Ag [Mass/volume] in Serum by Immunoassay HIV 1+2 Ab [Presence] in Unspecified specimen by Immunoassay HIV 1 Ab [Presence] in Cerebral spinal fluid by Immunofluorescence HIV 1 & 2 Ab [interpretation] in Serum Narrative HIV 1 RNA [Presence] in Cerebral spinal fluid by Probe & target amplification method HIV 1+2 IgM Ab [Units/volume] in Serum HIV 1+2 IgG Ab [Presence] in Serum HIV 1+2 Ab [Presence] in Unspecified specimen HIV 1 p24 Ab [Presence] in Serum
HIV 1 gp41 Ab [Presence] in Serum HIV 1 gp120+gp160 Ab [Presence] in Serum HIV 1 RNA [Presence] in Blood by Probe & target amplification method HIV 1 RNA [Presence] in Unspecified specimen by Probe & target amplification method HIV 1 Ab [Units/volume] in Serum by Immunoassay HIV 1 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 Ag [Presence] in Serum by Immunoassay HIV 1+2 Ab [Units/volume] in Serum by Immunoassay HIV 2 Ab [Units/volume] in Serum by Immunoassay HIV 2 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 Ab [Presence] in Serum HIV 1+2 Ab [Presence] in Serum HIV 2 Ab [Presence] in Serum HIV 1 gp160 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 gp120 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 gp41 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 p17 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 p24 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 p24 Ag [Units/volume] in Serum HIV 1 p31 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 p51 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 p55 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 p66 Ab [Presence] in Serum by Immunoblot (IB) HIV 1 p24 Ag [Presence] in Serum HIV DNA [Presence] in Blood by Probe with amplification HIV 1 DNA [Presence] in Blood by Probe with amplification
Prenatal encounter visit- enter in past medical history ICD9 Description V22.0 Supervision of normal first pregnancy V22.1 Supervision of other normal pregnancy V22.2 Pregnant state, incidental
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Prenatal Care: Anti-D Immune Globulin (NQF 0014) (Additional Measure MENU)
Description: Percentage of D (Rh) negative, unsensitized patients, regardless of age, who gave birth during a 12-month period who received anti-D immune globuline at 26-30 weeks gestation. Active diagnosis of delivery live births ICD-9 Descripition 640…649 Complications Mainly Related to Pregnancy Normal Delivery and other indications for care in Pregnancy, Labor and 650…659 Delivery 660…669 Complications Occurring Mainly in the Course of Labor and Delivery Active diagnosis of D(Rh) negative ICD-9 Descripition 656.1 Rhesus isoimmunization affecting management of mother Rhesus isoimmunization affecting management of mother, delivered, with or 656.11 without mention of antepartum condition Active diagnosis of primagravida SNO-MED Description 127364007 Primigravida 199719009 Elderly primigravida with antenatal problem 29399001 Elderly primigravida Active diagnosis of multigravida SNO-MED Description 102876002 Multigravida 127365008 Gravida 2 127366009 Gravida 3 127367000 Gravida 4 127368005 Gravida 5 127369002 Gravida 6 127370001 Gravida 7 127371002 Gravida 8 127372009 Gravida 9 127373004 Gravida 10 127374005 Gravida more than 10 17618008 Previous pregnancies 9 443460007 Multigravida of advanced maternal age 6867004 Previous pregnancies more than 10 80856001 Previous pregnancies 8 82634006 Previous pregnancies 10 Procedure performed of delivery live births CPT Descripition 59400 OB CARE ANTEPARTUM VAG DLVR&POSTPARTUM 59409 VAG DLVR ONLY 59410 VAG DLVR ONLY POSTPARTUM CARE 53
59425 ANTEPARTUM CARE ONLY 4-6 VSTS 59426 ANTEPARTUM CARE ONLY 7+ VSTS 59510 OB ANTEPARTUM CARE C DLVR&POSTPARTUM 59514 CESAREAN DELIVERY ONLY 59515 C DLVR ONLY W/POSTPARTUM CARE 59610 OB ANTEPARTUM VAG DLVR&POSTPARTUM AFTER C DLVR 59612 VAG DLVR AFTER C DLVR 59614 VAG DLVR AFTER C DLVR POSTPARTUM CARE 59618 ANTEPARTUM C DLVR&POSTPARTUM FA V AP C DLVER 59620 C DLVR ONLY FA V AP C DLVER 59622 C DLVR ONLY FA V AP C DLVER W/POSTPARTUM CARE Lab test result for Rh status mother with value = negative LOINC Description A_1155 Rh Status Mother 10331-7 Rh [Type] in Blood 1314-4 Rh immune globulin screen [interpretation] 14906-2 Rh [Type] in Cord blood 14907-0 Rh [Type] in Blood from Blood product unit 14908-8 Rh [Type] in Blood from newborn 17531-5 Rh [Type] in Amniotic fluid 34961-3 Rh [Type] in Blood by Confirm method Lab test result for Rh status baby with value = negative LOINC Description 10331-7 Rh [Type] in Blood 1314-4 Rh immune globulin screen [interpretation] 14906-2 Rh [Type] in Cord blood 14907-0 Rh [Type] in Blood from Blood product unit 14908-8 Rh [Type] in Blood from newborn 17531-5 Rh [Type] in Amniotic fluid 34961-3 Rh [Type] in Blood by Confirm method Medication Anti-D immune globulin administered RXNorm Description 205066 Rho(D) Immune Globulin 0.118 MG/ML Injectable Solution 247769 Rho(D) Immune Globulin 0.096 MG/ML Injectable Solution 351100 Rho(D) Immune Globulin 0.3 MG/ML Injectable Solution 406388 Rho(D) Immune Globulin 0.15 MG/ML Injectable Solution 562566 Rho(D) Immune Globulin 0.12 MG/ML Injectable Solution 616759 Rho(D) Immune Globulin 0.227 MG/ML Injectable Solution 731378 1 ML Rho(D) Immune Globulin 0.05 MG/ML Prefilled Syringe 731381 1 ML Rho(D) Immune Globulin 0.3 MG/ML Prefilled Syringe Encounter for a prenatal visit after the estimated date of conception (EDC) V22.0 Supervision of normal first pregnancy V22.1 Supervision of other normal pregnancy V22.2 Pregnant state, incidental
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Controlling High Blood Pressure (NQF 0018) (Additional Measure - MENU)
Definition: The percentage of patients 18-85 years of age who had a diagnosis of hypertension and who’s BP was adequately controlled during the measurement year. Diagnosis Hypertension ICD- 9 Description 401 Essential hypertension 401.0 Malignant essential hypertension 401.1 Benign essential hypertension 401.9 Unspecified essential hypertension Diagnosis Pregnancy ICD- 9 Description 630...633 Ectopic and Molar Pregnancy 634...639 Other Pregnancy with Abortive Outcome 640...649 Complications Mainly Related to Pregnancy Normal Delivery and other Indications for care in Pregnancy, Labor, and 650...659 Delivery 660...669 Complications Occurring Mainly in the Course of Labor and Delivery 670...677 Complications of the Puerperium V22.0 Supervision Of Normal First Pregnancy V22.1 Supervision Of Other Normal Pregnancy V22.2 Pregnant State, Incidental V23.0 Supervision Of High-risk Pregnancy With History Of Infertility V23.1 Supervision Of High-risk Pregnancy With History Of Trophoblastic Disease V23.2 Supervision Of High-risk Pregnancy With History Of Abortion V23.3 Supervision Of High-risk Pregnancy With Grand Multiparity V23.41 Supervision Of High-risk Pregnancy With history of pre-term labor V23.49 Supervision Of High-risk Pregnancy With other poor obstetric history V23.5 Supervision Of High-risk Pregnancy With Other Poor Reproductive History V23.7 Supervision Of High-risk Pregnancy With Insufficient Prenatal Care V23.81 Elderly primigravida V23.82 Elderly multigravida V23.83 Young primigravida V23.84 Young multigravida V23.85 Pregnancy resulting from assisted reproductive technology V23.86 Pregnancy with history of in utero procedure during previous pregnancy V23.89 Other high-risk pregnancy V23.9 Supervision of unspecified high-risk pregnancy V28.0 Encounter for antenatal screening for chromosomal anomalies by amniocentesis of mother V28.1 Encounter for antenatal screening for raised alpha-fetoprotein levels in amniotic fluid of mother V28.2 Encounter for other antenatal screening based on amniocentesis of mother 55
Encounter for routine antenatal screening for malformation using ultrasonics of mother Encounter for antenatal screening for fetal growth retardation using ultrasonics of mother Encounter for antenatal screening for isoimmunization of mother Encounter for antenatal screening for Streptococcus B of mother Encounter for fetal anatomic survey Encounter for screening for risk of pre-term labor Other specified antenatal screening Encounter for unspecified antenatal screening of mother
Diagnosis - ESRD ICD-9 V42.0 V45.1 V45.11 V45.12 V56 V56.0 V56.1 V56.2 V56.3 V56.31 V56.32 V56.8 585.6 585.5 Description Kidney replaced by transplant Postsurgical renal dialysis status Renal dialysis status Noncompliance with renal dialysis Encounter for dialysis and dialysis catheter care Encounter for extracorporeal dialysis Fitting and adjustment of extracorporeal dialysis catheter Fitting and adjustment of peritoneal dialysis catheter Encounter for adequacy testing for dialysis Encounter for adequacy testing for hemodialysis Encounter for adequacy testing for peritoneal dialysis Encounter for other dialysis End stage renal disease Chronic kidney disease, Stage V
Procedure – ESRD – Enter in Past Medical History if Reported CPT Description 38.95 Venous catheterization for renal dialysis 39.27 Arteriovenostomy for renal dialysis 39.42 Revision of arteriovenous shunt for renal dialysis 39.43 Removal of arteriovenous shunt for renal dialysis 39.53 Repair of arteriovenous fistula 39.93 Insertion of vessel-to-vessel cannula 39.94 Replacement of vessel-to-vessel cannula 39.95 Hemodialysis 54.98 Peritoneal dialysis 55.6 Transplant of kidney 55.61 Renal autotransplantation 55.69 Other kidney transplantation
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Smoking and Tobacco Use Cessation, Medical Assistance: (a) Advising (b) Discussing Medication (c) Discussing Strategies (NQF 0027) (Additional Measure - MENU)
Description: This measure facilitates efforts to implement recommended clinical practices and guidelines and subsequently reduce mortality rates and health problems related to smoking and tobacco use (Real-time Rule). Communication to Patient: Tobacco Use Cessation Counseling SNOMEDCT Descripition 171055003 Pregnancy smoking education 225323000 Smoking cessation education 225324006 Smoking effects education 315232003 Referral to stop-smoking clinic 384742004 Smoking cessation assistance 395700008 Referral to smoking cessation advisor Physical Exam Finding: Tobacco User SNOMEDCT Descripition 160603005 Light cigarette smoker (1-9 cigs/day) 160604004 Moderate cigarette smoker (10-19 cigs/day) 160605003 Heavy cigarette smoker (20-39 cigs/day) 160606002 Very heavy cigarette smoker (40+ cigs/day) 160619003 Rolls own cigarettes 228494002 Snuff user 228504007 User of moist powdered tobacco 228514003 Chews plug tobacco 228515002 Chews twist tobacco 228516001 Chews loose leaf tobacco 228517005 Chews fine cut tobacco 228518000 Chews products containing tobacco 230059006 Occasional cigarette smoker 230060001 Light cigarette smoker 230062009 Moderate cigarette smoker 230063004 Heavy cigarette smoker 230064005 Very heavy cigarette smoker 230065006 Chain smoker 266920004 Trivial cigarette smoker (less than one cigarette/day) (finding) 81703003 Chews tobacco 57
Encounter: Tobacco Use Cessation Counseling CPT Descripition 99406 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES 99407 TOBACCO USE CESSATION INTENSIVE >10 MINUTES
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Breast Cancer Screening (NQF 0031) (Additional Measure - MENU)
Description: The percentage of women 40-69 years of age who had a mammogram to screen for breast cancer. Mammograms – Enter in Past Medical History CPT Description 76090 MAMMOGRAPY UNI 76091 MAMMOGRAPY BI 76092 SCR MAMMOGRAPY BI 2 VIEW FLM STD EA BRST 77055 MAMMOGRAPHY UNILATERAL 77056 MAMMOGRAPHY BILATERAL 77057 SCREENING MAMMOGRAPHY BILATERAL SNO-MED 12389009 241055006 241056007 241057003 241058008 241189009 241539009 24623002 258172002 35482003 418074003 418378007 43204002 439324009 71651007 Description Xeromammography Mammogram - symptomatic Mammogram - localization Mammogram coned Mammogram magnification Breast sinogram CT of breast Screening mammography Stereotactic mammography Partial mastectomy with axillary lymphadenectomy Mammography and aspiration Mammography and biopsy Bilateral mammography Mammogram in compression view Mammography
Bilateral mastectomy – Enter in past surgical history CPT Description 19180 MAST SMPL COMPL 19200 MAST RAD W/PECTORAL MUSC AX LYMPH NOD 19220 MAST RAD W/PECTORAL MUSC AX&INT MAM LYMPH NOD 19240 MAST MODF RAD W/AX LYMPH NOD +-PECTORALIS MINOR 19303 MASTECTOMY SIMPLE COMPLETE 19304 MASTECTOMY SUBCUTANEOUS 19305 MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES 19306 MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES 19307 MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
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Unilateral mastectomy- enter in past surgical history CPT Description 19180 MAST SMPL COMPL 19200 MAST RAD W/PECTORAL MUSC AX LYMPH NOD 19220 MAST RAD W/PECTORAL MUSC AX&INT MAM LYMPH NOD 19240 MAST MODF RAD W/AX LYMPH NOD +-PECTORALIS MINOR 19303 MASTECTOMY SIMPLE COMPLETE 19304 MASTECTOMY SUBCUTANEOUS 19305 MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES 19306 MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES 19307 MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
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Cervical Cancer Screening (NQF 0032) (Additional Measure - MENU)
Description: The percentage of women 21-64 years of age who received one or more Pap tests to screen for cervical cancer. Hysterectomy procedure CPT Description 51925 CLSR VESICOUTERINE FSTL W/HYST 58150 TAH +-RMVL TUBE +-RMVL OVARY 58152 TAH +-RMVL TUBE OVARY COLPO-URTCSTOPEXY 58200 TAH W/PRTL VAGNC PEL LYMPH NODE SAMPLING 58210 RAD ABDL HYST W/BI PEL LMPHADEC 58240 PEL EXNTJ GYNECOLOGIC MAL 58260 VAG HYST 250 GM/< 58262 VAG HYST 250 GM/< W/RMVL TUBE&/OVARY 58263 VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL 58267 VAG HYST 250 GM/< W/COLPO-URTCSTOPEXY 58270 VAG HYST 250 GM/< W/RPR NTRCL 58275 VAG HYST W/TOT/PRTL VAGNC 58280 VAG HYST W/TOT/PRTL VAGNC W/RPR NTRCL 58285 VAG HYST RAD SCHAUTA 58290 VAG HYST F/UTER > 250 GM 58291 VAG HYST > 250 GM RMVL TUBE&/OVARY 58292 VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR NTRCL 58293 VAG HYST > 250 GM COLPO-URTCSTOPEXY +-NDSC CTRL 58294 VAG HYST > 250 GM RPR NTRCL 58550 LAPS W/VAG HYST 250 GM/< 58552 LAPS W/VAG HYST 250 GM/< RMVL TUBE&/OVARY 58553 LAPS W/VAG HYST > 250 GRAMS 58554 LAPS VAG HYST > 250 GM RMVL TUBE&/OVARY 58570 58571 58572 58573 58951 58953 58954 58956 59135 LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 G/< LAPS TOTAL HYSTERECTOMY 250 G/<W TUBE/OVARY LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS>250 G LAPAROSCOPY TOT HYSTERECTOMY >250 G W TUBE/OVARY RESCJ PRIM PRTL MAL W/BSO&OMNTC TAH&LMPHADEC BSO W/OMNTC TAH&RAD DSJ DEBULKING BSO W/OMNTC TAH DEBULKING W/LMPHADEC BSO TOT OMNTC TAH MAL TX ECTOPIC PREGNANCY NTRSTL REQ TOT HYST
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Lab test result for a pap test LOINC 10524-7 18500-9 19762-4 19764-0 19765-7 19766-5 19774-9 33717-0 47527-7 47528-5 Description Microscopic observation [Identifier] in Cervix by Cyto stain Microscopic observation [Identifier] in Cervix by Cyto stain.thin prep General categories [interpretation] of Cervical or vaginal smear or scraping by Cyto stain Statement of adequacy [interpretation] of Cervical or vaginal smear or scraping by Cyto stain Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain Cytology study comment Cervical or vaginal smear or scraping Cyto stain Cytology Cervical or vaginal smear or scraping study Cytology report of Cervical or vaginal smear or scraping Cyto stain.thin prep Cytology report of Cervical or vaginal smear or scraping Cyto stain
One encounter (OB/Gyn or outpatient) - Enter Past medical History ICD9 Description V24 Postpartum care and examination V25 Encounter for contraceptive management V26 Procreative management V27 Outcome of delivery V28 Encounter for antenatal screening of mother V45.5 Presence of contraceptive device V61.5 Multiparity V61.6 Illegitimacy or illegitimate pregnancy V61.7 Other unwanted pregnancy V69.2 High-risk sexual behavior V72.3 Special investigations and examinations - Gynecological examination V72.4 Pregnancy examination or test
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Chlamydia Screening for Women (NQF 0033) (Additional Measure - MENU)
Description: Chlamydia is one of the most frequently occurring sexually transmitted diseases in the U.S. Women ages 14-30 account for 80% of new cases. This measure facilitates efforts towards early screening and treatment to improve health outcomes for infected women and prevent the spread of disease (Real-Time Rule). Sexually active woman – Diagnosis active ICD-9-CM Descripition 054.10 Genital herpes, unspecified 054.11 Herpetic vulvovaginitis 054.12 Herpetic ulceration of vulva 054.19 Other genital herpes 078.11 Condyloma acuminatum 078.88 Other specified diseases due to Chlamydiae Human papillomavirus infection in conditions classified elsewhere and of 079.4 unspecified site Human T-cell lymphotrophic virus, type I [HTLV-I] infection in conditions 079.51 classified elsewhere and of unspecified site Human T-cell lymphotrophic virus, type II [HTLV-II] infection in conditions 079.52 classified elsewhere and of unspecified site Human immunodeficiency virus, type 2 [HIV-2] infection in conditions 079.53 classified elsewhere and of unspecified site Other specified chlamydial infection in conditions classified elsewhere and of 079.88 unspecified site Unspecified chlamydial infection in conditions classified elsewhere and of 079.98 unspecified site 091 Early syphilis, symptomatic 091.0 Genital syphilis (primary) 091.1 Primary anal syphilis 091.2 Other primary syphilis 091.3 Secondary syphilis of skin or mucous membranes 091.4 Adenopathy due to secondary syphilis 091.5 Uveitis due to secondary syphilis 091.50 Syphilitic uveitis, unspecified 091.51 Syphilitic chorioretinitis (secondary) 091.52 Syphilitic iridocyclitis (secondary) 091.6 Secondary syphilis of viscera and bone 091.61 Secondary syphilitic periostitis 091.62 Secondary syphilitic hepatitis 091.69 Secondary syphilis of other viscera 091.7 Secondary syphilis, relapse 091.8 Other forms of secondary syphilis 091.81 Acute syphilitic meningitis (secondary) 091.82 Syphilitic alopecia 63
091.89 091.9 092 092.0
Other forms of secondary syphilis Unspecified secondary syphilis Early syphilis, latent Early syphilis, latent, serological relapse after treatment
Chlamydia Screening: Laboratory Test Result LOINC Description 14463-4 Chlamydia trachomatis [Presence] in Cervix by Organism specific culture 14464-2 14467-5 14470-9 14471-7 14474-1 14509-4 Chlamydia trachomatis [Presence] in Vaginal fluid by Organism specific culture Chlamydia trachomatis [Presence] in Urine sediment by Organism specific culture Chlamydia trachomatis Ag [Presence] in Cervix by Immunoassay Chlamydia trachomatis Ag [Presence] in Vaginal fluid by Immunoassay Chlamydia trachomatis Ag [Presence] in Urine sediment by Immunoassay Chlamydia trachomatis Ag [Presence] in Cervix by Immunofluorescence
Chlamydia trachomatis Ag [Presence] in Vaginal fluid by Immunofluorescence Chlamydia trachomatis Ag [Presence] in Urine sediment by Immunofluorescence Chlamydia trachomatis rRNA [Presence] in Genital specimen by DNA probe Chlamydia trachomatis rRNA [Presence] in Urine by DNA probe Chlamydia trachomatis DNA [Presence] in Cervical mucus by Probe & target amplification method Chlamydia trachomatis DNA [Presence] in Cervix by Probe & target amplification method Chlamydia trachomatis DNA [Presence] in Urethra by Probe & target amplification method Chlamydia trachomatis rRNA [Presence] in Urethra by DNA probe Chlamydia trachomatis DNA [Presence] in Unspecified specimen by Probe & target amplification method Chlamydia trachomatis rRNA [Presence] in Genital fluid by DNA probe Chlamydia trachomatis Ag [Presence] in Cervix Chlamydia trachomatis Ag [Presence] in Vaginal fluid Chlamydia trachomatis Ag [Presence] in Urine sediment Chlamydia trachomatis Ag [Presence] in Unspecified specimen Chlamydia trachomatis rRNA [Presence] in Unspecified specimen by DNA probe Chlamydia trachomatis rRNA [Presence] in Cervix by Probe & target amplification method Chlamydia trachomatis rRNA [Presence] in Urethra by Probe & target amplification method Chlamydia trachomatis rRNA [Presence] in Vaginal fluid by Probe & target amplification method
Laboratory Test indicative of sexually active woman – Laboratory test performed LOINC Descripition 10705-2 Human papilloma virus Ag [Presence] in Tissue by Immune stain 11083-3 Human papilloma virus identified in Cervix 67
Reagin Ab [Titer] in Serum Human papilloma virus identified in Unspecified specimen Treponema pallidum Ab [Units/volume] in Serum Human papilloma virus Ag [Presence] in Genital specimen Human papilloma virus 16+18 Ag [Presence] in Genital specimen Human papilloma virus Ag [Presence] in Cervix Human papilloma virus Ag [Presence] in Vaginal fluid Human papilloma virus Ag [Presence] in Urethra Human papilloma virus 16+18 Ag [Presence] in Cervix Human papilloma virus 16+18 Ag [Presence] in Vaginal fluid Human papilloma virus 16+18 Ag [Presence] in Urethra Alpha-1-Fetoprotein [Moles/volume] in Amniotic fluid Human papilloma virus DNA [Presence] in Unspecified specimen by Probe with amplification Human papilloma virus 11 Ag [Presence] in Unspecified specimen Human papilloma virus 16 Ag [Presence] in Unspecified specimen Human papilloma virus 16+18 Ag [Presence] in Unspecified specimen Human papilloma virus 18 Ag [Presence] in Unspecified specimen Human papilloma virus 31 Ag [Presence] in Unspecified specimen Human papilloma virus 31+33+35 Ag [Presence] in Unspecified specimen Human papilloma virus 33 Ag [Presence] in Unspecified specimen Human papilloma virus 42 Ag [Presence] in Unspecified specimen Human papilloma virus 43 Ag [Presence] in Unspecified specimen Human papilloma virus 44 Ag [Presence] in Unspecified specimen Human papilloma virus 45 Ag [Presence] in Unspecified specimen Human papilloma virus 5 Ag [Presence] in Unspecified specimen Human papilloma virus 51 Ag [Presence] in Unspecified specimen
Pregnancy Test – Laboratory test performed LOINC Descripition 19080-1 Choriogonadotropin [Units/volume] in Serum or Plasma 19180-9 Choriogonadotropin.beta subunit free [Units/volume] in Serum or Plasma Choriogonadotropin.beta subunit [Units/volume] in Serum or Plasma by 20415-6 Immunoassay (EIA) 3rd IS 20994-0 Choriogonadotropin [interpretation] in Serum or Plasma 2106-3 Choriogonadotropin [Presence] in Urine 2107-1 Choriogonadotropin [Moles/volume] in Urine 2110-5 Choriogonadotropin.beta subunit [Presence] in Serum or Plasma 2111-3 Choriogonadotropin.beta subunit [Moles/volume] in Serum or Plasma 2112-1 Choriogonadotropin.beta subunit [Presence] in Urine 2113-9 Choriogonadotropin.beta subunit [Mass/time] in 24 hour Urine 2114-7 Choriogonadotropin.beta subunit [Moles/volume] in Urine 68
Choriogonadotropin.beta subunit free [Moles/volume] in Serum or Plasma Choriogonadotropin [Presence] in Serum or Plasma Choriogonadotropin [Moles/volume] in Serum or Plasma Choriogonadotropin.beta subunit [Units/volume] in Serum or Plasma Choriogonadotropin [Units/volume] in Urine Choriogonadotropin.beta subunit free [Mass/volume] in Serum or Plasma Choriogonadotropin [Mass/volume] in Serum or Plasma
Encounter: Pregnancy ICD-9-CM Descripition V24 Postpartum care and examination V24.0 Postpartum care and examination immediately after delivery V24.2 Routine postpartum follow-up V25 Encounter for contraceptive management V25.01 Encounter for general counseling on prescription of oral contraceptives Encounter for general counseling on initiation of other contraceptive V25.02 measures V25.03 Encounter for emergency contraceptive counseling and prescription Encounter for other general counseling and advice on contraceptive V25.09 management V26.81 Encounter for assisted reproductive fertility procedure cycle V28 Encounter for antenatal screening of mother Encounter for routine antenatal screening for malformation using ultrasonics V28.3 of mother V28.81 Encounter for fetal anatomic survey V28.82 Encounter for screening for risk of pre-term labor V72.4 Pregnancy examination or test V72.40 Pregnancy examination or test, pregnancy unconfirmed V72.41 Pregnancy examination or test, negative result V72.42 Pregnancy examination or test, positive result
70
Colorectal Cancer Screening (NQF 0034) (Additional Measure - MENU)
Description: The percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer. Diagnosis of colorectal cancer ICD-9 Description 153 Malignant neoplasm of colon 153.1 Malignant neoplasm of transverse colon 153.2 Malignant neoplasm of descending colon 153.3 Malignant neoplasm of sigmoid colon 153.4 Malignant neoplasm of cecum 153.5 Malignant neoplasm of appendix vermiformis 153.6 Malignant neoplasm of ascending colon 153.7 Malignant neoplasm of splenic flexure 153.8 Malignant neoplasm of other specified sites of large intestine 153.9 Malignant neoplasm of colon, unspecified 154 Malignant neoplasm of rectum, rectosigmoid junction, and anus 154.1 Malignant neoplasm of rectum 197.5 Secondary malignant neoplasm of large intestine and rectum V10.05 Personal history of malignant neoplasm of large intestine Total colectomy CPT 44150 44151 44152 44153 44155 44156 44157 44158 44210 44211 44212 Description COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST COLCT TOT ABDL W/O PRCTECT W/MUCOSEC ANAST COLCT TOT ABDL W/O PRCTECT W/MUCOSEC ANAST RSVR COLCT TOT ABDL W/PRCTECT W/ILEOST COLCT TOT ABDL W/PRCTECT W/CONTINENT ILEOST COLCT TTL ABD W/PRCTECT ILEOANAL ANAST COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR LAPS COLCT TOT W/O PRCTECT W/ILEOST/ILEOPXTS LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANAST&RSVR LAPS COLCT ABDL W/PRCTECT W/ILEOST
Flexible sigmoidoscopy CPT 45330 45331 45332 45333 45334 45335 71 Description SCOPE OF SIGMOID COLON ONLY FOR DIAGNOSIS SCOPE OF SIGMOID COLON ONLY WITH BIOPSY SGMDSC FLX RMVL FB SGMDSC FLX RMVL LES CAUT SGMDSC FLX CTRL BLD SGMDSC FLX DIRED SBMCSL NJX ANY SBST
45337 45338 45339 45340 45341 45342 45345
SGMDSC FLX DCMPRN VOLVULUS ANY METH SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ SGMDSC FLX ABLTJ LES SGMDSC FLX DILAT BALO 1/MORE STRIXS SGMDSC FLX NDSC US XM SGMDSC FLX TNDSC US GID NDL ASPIR/BX SGMDSC FLX TNDSC STENT PLMT
Double contrast barium enema (DCBE, CPT code 74280) during the measurement year or the 4 years prior to the measurement year Colonoscopy CPT 44388 44389 44390 44391 44392 44393 44394 44397 45355 45378 45379 45380 45381 45382 45383 45384 45385 45386 45387 45391 45392 Description SCOPE OF COLON THRU OSTOMY FOR DIAGNOSIS SCOPE OF COLON WITH BIOPSY THRU OSTOMY COLSC THRU STOMA W/RMVL FB COLSC THRU STOMA CTRL BLD COLSC THRU STOMA RMVL LES CAUT COLSC THRU STOMA ABLTJ LES COLSC THRU STOMA W/RMVL TUM POLYP/OTH LES SNARE COLSC THRU STOMA W/TNDSC STENT PLMT COLSC RGD/FLX TABDL VIA COLOTOMY 1/MLT SCOPE OF COLON FOR DIAGNOSIS COLSC FLX PROX SPLENIC FLXR RMVL FB SCOPE OF COLON WITH BIOPSY COLSC FLX PROX SPLENIC FLXR SBMCSL NJX COLSC FLX PROX SPLENIC FLXR CTRL BLD COLSC FLX PROX SPLENIC FLXR ABLTJ LES COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ COLSC FLX PROX SPLENIC FLXR DILAT BALO 1+ STRIXS COLSC FLX PROX SPLENIC FLXR TNDSC STENT PLMT COLSC FLX PROX SPLENIC FLXR NDSC US XM COLSC FLX PROX SPLENIC FLXR US GID NDL ASPIR/BX
Fecal occult blood test during the measurement year 12503-9 Hemoglobin.gastrointestinal [Presence] in Stool --4th specimen 12504-7 Hemoglobin.gastrointestinal [Presence] in Stool --5th specimen 14563-1 Hemoglobin.gastrointestinal [Presence] in Stool --1st specimen 14564-9 Hemoglobin.gastrointestinal [Presence] in Stool --2nd specimen 14565-6 Hemoglobin.gastrointestinal [Presence] in Stool --3rd specimen 2335-8 Hemoglobin.gastrointestinal [Presence] in Stool 27396-1 Hemoglobin.gastrointestinal [Mass/mass] in Stool 27401-9 Hemoglobin.gastrointestinal [Presence] in Stool --6th specimen 72
27925-7 27926-5 29771-3
Hemoglobin.gastrointestinal [Presence] in Stool --7th specimen Hemoglobin.gastrointestinal [Presence] in Stool --8th specimen Hemoglobin.gastrointestinal [Presence] in Stool by Immunologic method
73
Use of Appropriate Medications for Asthma (NQF 0036) (Additional Measure
- MENU)
Description: Assesses the appropriate and timely use of medication for long-term control of asthma symptoms. The measure facilitates efforts toward effective disease management and prevention of traumatic outcomes (Real-Time Rule). Use of Appropriate Medications for Asthma – Encounter Acute Inpatient CPT Description 99221 1ST HOSP CARE PR D 30 MIN 99222 1ST HOSP CARE PR D 50 MIN 99223 1ST HOSP CARE PR D 70 MIN 99231 SBSQ HOSP CARE PR D 15 MIN 99232 SBSQ HOSP CARE PR D 25 MIN 99233 SBSQ HOSP CARE PR D 35 MIN 99238 HOSP DSCHRG D MGMT 30 MIN/< 99239 HOSP DSCHRG D MGMT > 30 MIN 99251 1ST INPT CONSLTJ 20 MIN 99252 1ST INPT CONSLTJ 40 MIN 99253 1ST INPT CONSLTJ 55 MIN 99254 1ST INPT CONSLTJ 80 MIN 99255 1ST INPT CONSLTJ 110 MIN 99291 CC E/M CRITICALLY ILL/INJURED 1ST 30-74 MIN Use of Appropriate Medications for Asthma – Encounter ED CPT Description 99281 EMER DEPT SELF LIMITED/MINOR 99282 EMER DEPT LOW TO MODERATE SEVERITY 99283 EMER DEPT MODERATE SEVERITY 99284 EMER DEPT HI SEVERITY&URGENT EVAL 99285 EMER DEPT HIGH SEVERITY&THREAT FUNCJ Use of Appropriate Medications for Asthma – Active Diagnosis of Acute Respiratory Failure ICD-9-CM Description 518.81 Acute respiratory failure Use of Appropriate Medications for Asthma – Active Diagnosis of Asthma ICD-9-CM Description 493.00 Asthma 493.01 Extrinsic asthma with status asthmaticus 493.02 Extrinsic asthma, with (acute) exacerbation 493.10 Intrinsic asthma 493.11 Intrinsic asthma with status asthmaticus 74
Intrinsic asthma, with (acute) exacerbation Chronic obstructive asthma Chronic obstructive asthma, with status asthmaticus Chronic obstructive asthma, with (acute) exacerbation Exercise induced bronchospasm Cough variant asthma Asthma, unspecified Asthma, unspecified type, with status asthmaticus Asthma, unspecified with (acute) exacerbation
Use of Appropriate Medications for Asthma – Active Diagnosis of COPD ICD-9-CM Description 491.2 Obstructive chronic bronchitis 491.21 Obstructive chronic bronchitis with (acute) exacerbation 491.22 Obstructive chronic bronchitis with acute bronchitis 492 Emphysema 493.2 Chronic obstructive asthma 493.21 Chronic obstructive asthma, with status asthmaticus 493.22 Chronic obstructive asthma, with (acute) exacerbation 496 Chronic airway obstruction, not elsewhere classified 506.4 Chronic respiratory conditions due to fumes and vapors Use of Appropriate Medications for Asthma – Active Diagnosis of Cystic Fibrosis ICD-9-CM Description 277.0 Cystic fibrosis 277.00 Cystic fibrosis without mention of meconium ileus 277.01 Cystic fibrosis with meconium ileus 277.02 Cystic fibrosis with pulmonary manifestations 277.03 Cystic fibrosis with gastrointestinal manifestations 277.09 Cystic fibrosis with other manifestations Use of Appropriate Medications for Asthma – Active Diagnosis of Emphysema ICD-9-CM Description 492 Emphysema 492.8 Other emphysema 518.1 Interstitial emphysema 518.2 Compensatory emphysema Use of Appropriate Medications for Asthma – Antiasthmatic Combinations of Medication Active, Ordered, or Dispensed RxNorm Description 197639 Dyphylline 200 MG / Guaifenesin 200 MG Oral Tablet 198266 Guaifenesin 180 MG / Theophylline 300 MG Oral Capsule 75
Pneumonia Vaccination Status for Older Adults (NQF 0043) (Additional Measure - MENU)
Definition: The percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine. RxNorm 854931 854933 854935 854937 854939 854941 854943 854945 854947 854949 854951 854953 854955 854957 854959 854961 854963 854965 854967 854969 854971 854973 854975 Description pneumococcal capsular polysaccharide type 1 vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 10A vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 11A vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 12F vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 14 vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 15B vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 17F vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 18C vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 19A vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 19F vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 2 vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 20 vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 22F vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 23F vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 3 vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 33F vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 4 vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 5 vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 6B vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 7F vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 8 vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 9N vaccine 0.05 MG/ML pneumococcal capsular polysaccharide type 9V vaccine 0.05 MG/ML
88
854977
pneumococcal capsular polysaccharide type 1 vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 10A vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 11A vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 12F vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 14 vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 15B vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 17F vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 18C vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 19A vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 19F vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 2 vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 20 vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 22F vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 23F vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 3 vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 33F vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 4 vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 5 vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 6B vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 7F vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 8 vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 9N vaccine 0.05 MG/ML / pneumococcal capsular polysaccharide type 9V vaccine 0.05 MG/ML Injectable Solution
89
Asthma Pharmacologic Therapy (NQF 0047) (Additional Measure - MENU)
Description: "Percentage of patients aged 5 through 40 years with a diagnosis of mild, moderate, or severe persistent asthma who were prescribed either the preferred long-term control medication (inhaled corticosteroid) or an acceptable alternative treatment." Diagnosis of Persistent Asthma SNOMED Description 426656000 Severe persistent asthma 426979002 Mild persistent asthma 427295004 Moderate persistent asthma
Description Asthma Extrinsic asthma with status asthmaticus Extrinsic asthma, with (acute) exacerbation Intrinsic asthma Intrinsic asthma with status asthmaticus Intrinsic asthma, with (acute) exacerbation Chronic obstructive asthma Chronic obstructive asthma, with status asthmaticus Chronic obstructive asthma, with (acute) exacerbation Exercise induced bronchospasm Cough variant asthma Asthma, unspecified Asthma, unspecified type, with status asthmaticus Asthma, unspecified with (acute) exacerbation
Low Back Pain – Use of Imaging Studies (NQF 0052) (Additional Measure MENU)
Description: Low back pain is a prevalent diagnosis and normally does not warrant imaging studies within the first month (Retrospective and Negative Rule). Active or inactive diagnosis of cancer ICD-9 Description Codes 140.0 through 238.9 Codes V10 through V10.9 (approximately 1000 codes) Diagnosis Active – IV drug abuse ICD-9CM Description 304.0 Opioid type dependence 304.00 Opioid type dependence, unspecified use 304.01 Opioid type dependence, continuous use 304.02 Opioid type dependence, episodic use 304.03 Opioid type dependence, in remission 304.1 Sedative, hypnotic or anxiolytic dependence 304.10 Sedative, hypnotic or anxiolytic dependence, unspecified 304.11 Sedative, hypnotic or anxiolytic dependence, continuous 304.12 Sedative, hypnotic or anxiolytic dependence, episodic 304.13 Sedative, hypnotic or anxiolytic dependence, in remission 304.2 Cocaine dependence 304.20 Cocaine dependence, unspecified use 304.22 Cocaine dependence, episodic use 304.23 Cocaine dependence, in remission 304.4 Amphetamine and other psychostimulant dependence 304.40 Amphetamine and other psychostimulant dependence, unspecified use 304.41 Amphetamine and other psychostimulant dependence, continuous use 304.42 Amphetamine and other psychostimulant dependence, episodic use 304.43 Amphetamine and other psychostimulant dependence, in remission 305.4 Sedative, hypnotic or anxiolytic abuse 305.40 Sedative, hypnotic or anxiolytic abuse, unspecified 305.41 Sedative, hypnotic or anxiolytic abuse, continuous 305.42 Sedative, hypnotic or anxiolytic abuse, episodic 305.43 Sedative, hypnotic or anxiolytic abuse, in remission 305.50 Opioid abuse, unspecified use 305.51 Opioid abuse, continuous use 305.52 Opioid abuse, episodic use 305.53 Opioid abuse, in remission 305.60 Cocaine abuse, unspecified use
Cocaine abuse, continuous use Cocaine abuse, episodic use Cocaine abuse, in remission Amphetamine or related acting sympathomimetic abuse Amphetamine or related acting sympathomimetic abuse, unspecified use Amphetamine or related acting sympathomimetic abuse, continuous use Amphetamine or related acting sympathomimetic abuse, episodic use Amphetamine or related acting sympathomimetic abuse, in remission
Diagnosis Active – low back pain ICD-9CM Description 721.3 Lumbosacral spondylosis without myelopathy 722.10 Displacement of lumbar intervertebral disc without myelopathy 722.32 Schmorl's nodes of lumbar region 722.52 Degeneration of lumbar or lumbosacral intervertebral disc 722.93 Other and unspecified disc disorder of lumbar region 724 Other and unspecified disorders of back 724.02 Spinal stenosis of lumbar region without neurogenic claudication 724.2 Lumbago 724.3 Sciatica 724.5 Backache, unspecified 724.7 Disorders of coccyx 738.5 Other acquired deformity of back or spine 739.3 Nonallopathic lesions of lumbar region, not elsewhere classified 739.4 Nonallopathic lesions of sacral region, not elsewhere classified 846.0 Lumbosacral (joint) (ligament) sprain 846.1 Sacroiliac (ligament) sprain 846.2 Sacrospinatus (ligament) sprain 846.3 Sacrotuberous (ligament) sprain 846.8 Other specified sites of sacroiliac region sprain 846.9 Unspecified site of sacroiliac region sprain Diagnosis Active – neurologic impairment ICD-9CM Description 344.6 Cauda equina syndrome 729.2 Neuralgia, neuritis, and radiculitis, unspecified
Encounter - ED CPT Description 99281 EMER DEPT SELF LIMITED/MINOR 99282 EMER DEPT LOW TO MODERATE SEVERITY 99283 EMER DEPT MODERATE SEVERITY 99284 EMER DEPT HI SEVERITY&URGENT EVAL 99285 EMER DEPT HIGH SEVERITY&THREAT FUNCJ
98
Diabetes: Eye Exam (NQF 0055) (Additional Measure – MENU)
Description: The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional . Diagnosis: Diabetes ICD-9 Description 250 Diabetes Mellitus 250.0 Diabetes Mellitus Without Mention Of Complication 250.00 Diabetes Mellitus Without Mention Of Complication, type two or unspecified type, not stated as uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin, 250.01 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], not stated as uncontrolled, 250.02 Diabetes Mellitus Without Mention Of Complication, Type two or unspecified type, uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.03 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], uncontrolled 250.10 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.11 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type] Not Stated As Uncontrolled 250.12 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.13 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type], Uncontrolled 250.20 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.21 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Not Stated As Uncontrolled 250.22 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.23 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Uncontrolled 250.30 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.31 Diabetes Mellitus With Other Coma, Type One [juvenile], Not Stated As Uncontrolled 250.32 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.33 Diabetes Mellitus With Other Coma, Type One [juvenile], Uncontrolled 250.4 Diabetes With Renal Manifestations
99
250.40
250.41 250.42
250.43 250.50
250.51 250.52
250.53 250.60
250.61 250.62
250.63 250.7 250.70
250.71 250.72
250.73 250.8 250.80
250.81 250.82
Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type]. Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Not Stated As Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Uncontrolled Diabetes With Peripheral Circulatory Disorders Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Uncontrolled Diabetes With Other Specified Manifestations Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two
patients, even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Uncontrolled Diabetes With Unspecified Complication Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Uncontrolled Polyneuropathy In Diabetes Diabetic Retinopathy Background Diabetic Retinopathy Proliferative Diabetic Retinopathy Nonproliferative diabetic retinopathy NOS Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic retinopathy Severe nonproliferative diabetic retinopathy Diabetic macular edema Diabetic Cataract Diabetes Mellitus Complicating Pregnancy, Childbirth, Or The Puerperium Diabetes Mellitus Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care Diabetes Mellitus Of Mother, With Delivery
Active diagnosis of polycystic ovaries 256.4 Polycystic Ovaries Diagnosis Active of gestational diabetes 648.8 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium 648.80 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care 648.81 Abnormal Glucose Tolerance Of Mother, With Delivery 648.82 Abnormal Glucose Tolerance Of Mother, With Delivery, With Mention Of Postpartum Complication 648.83 Abnormal Glucose Tolerance Of Mother, Antepartum 648.84 Abnormal Glucose Tolerance Of Mother, Postpartum Diagnosis Active of Steroid induced diabetes 249 Secondary Diabetes Mellitus 249.0 Secondary diabetes mellitus without mention of complication 249.00 Secondary diabetes mellitus without mention of complication, not stated as uncontrolled or unspecified 249.01 Secondary diabetes mellitus without mention of complication, uncontrolled 101
Secondary diabetes mellitus without mention of complication Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with ketoacidosis, uncontrolled Secondary diabetes mellitus with hyperosmolarity Secondary diabetes mellitus with hyperosmolarity, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with hyperosmolarity, uncontrolled Secondary diabetes mellitus with other coma Secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with other coma, uncontrolled Secondary diabetes mellitus with renal manifestations Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with renal manifestations, uncontrolled Secondary diabetes mellitus with ophthalmic manifestations Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled Secondary diabetes mellitus with neurological manifestations Secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with neurological manifestations, uncontrolled Secondary diabetes mellitus with peripheral circulatory disorders Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with peripheral circulatory disorders, uncontrolled Secondary diabetes mellitus with other specified manifestations Secondary diabetes mellitus with other specified manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with other specified manifestations, uncontrolled Secondary diabetes mellitus with unspecified complication Secondary diabetes mellitus with unspecified complication, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with unspecified complication, uncontrolled Other Specified Disorders Of Pancreatic Internal Secretion Poisoning By Adrenal Cortical Steroids
Encounter Codes Accepted for appointment outside of Physician using MU: Encounte CPT Encounter Encounter Encounter CPT CPT CPT r Acute ED Non-Acute Outpatient Inpatient Inpatient Opthamolo gical services 99221 1ST HOSP CARE PR D 30 MIN 99222 1ST HOSP CARE PR D 50 MIN 99281 EMER DEPT SELF LIMITED/MI NOR EMER DEPT LOW TO MODERAT E SEVERITY EMER DEPT MODERAT E SEVERITY EMER DEPT HI 99304 1ST NF CARE PR D E/M LW SEVERITY 92002 OPH MEDICAL XM&EVAL INTRM NEW PT OPH MEDICAL XM&EVAL COMPRE NEW PT 1+ VST OPH MEDICAL XM&EVAL INTRM EST PT OPH MEDICAL
99232 SBSQ HOSP CARE PR D 25 MIN 99233 SBSQ HOSP CARE PR D 35 MIN 99238 HOSP DSCHRG D MGMT 30 MIN/ 99239 HOSP DSCHRG D MGMT > 30 MIN 99251 1ST INPT 99252 CONSLTJ 20 MIN 1ST INPT CONSLTJ 40 MIN 99253 1ST INPT CONSLTJ 55 MIN 99254 1ST INPT CONSLTJ 80 MIN 99255 1ST INPT CONSLTJ 110 MIN
SBSQ NF CARE PR D E/M MINOR COMPLCTJ SBSQ NF CARE PR D E/M NEW PROBLEM SBSQ NF CARE PR D E/M UNSTABLE/N EW PROBLEM NF DSCHRG D MGMT 30 MIN/< NF DSCHRG D MGMT > 30 MIN
99309
99310
99315
99316
99318
99324
E/M PT INVG ANNUAL NF ASSMT DOM/R-HOME LW SEVERITY DOM/R-HOME E/M NEW PT MOD SEVERITY DOM/R-HOME E/M NEW PT MOD HI SEVERITY DOM/R-HOME E/M NEW PT HI SEVERITY DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM
99325
99326
99327
99328
110
99334
99335
99337
DOM/R-HOME E/M EST PT SELFLMTD/MINOR DOM/R-HOME E/M EST PT LW MOD SEVERITY DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM
111
Diabetes: Foot Exam (NQF 0056) (Additional Measure - MENU)
Description: The percentage of patients aged 18‐75 years with diabetes (type 1 or type 2) who had a foot exam (visual inspection, sensory exam with monofilament, or pulse exam). Diagnosis – Diabetes ICD-9 Description 250 Diabetes Mellitus 250.0 Diabetes Mellitus Without Mention Of Complication 250.00 Diabetes Mellitus Without Mention Of Complication, type two or unspecified type, not stated as uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin, 250.01 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], not stated as uncontrolled, 250.02 Diabetes Mellitus Without Mention Of Complication, Type two or unspecified type, uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.03 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], uncontrolled 250.10 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.11 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type] Not Stated As Uncontrolled 250.12 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.13 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type], Uncontrolled 250.20 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.21 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Not Stated As Uncontrolled 250.22 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.23 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Uncontrolled 250.30 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.31 Diabetes Mellitus With Other Coma, Type One [juvenile], Not Stated As Uncontrolled 250.32 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.33 Diabetes Mellitus With Other Coma, Type One [juvenile], Uncontrolled 250.4 Diabetes With Renal Manifestations 250.40 Diabetes Mellitus With Renal Manifestations, Type Two or unspecified 112
250.41 250.42
250.43 250.50
250.51 250.52
250.53 250.60
250.61 250.62
250.63 250.7 250.70
250.71 250.72
250.73 250.8 250.80
type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type]. Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Not Stated As Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Uncontrolled Diabetes With Peripheral Circulatory Disorders Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Uncontrolled Diabetes With Other Specified Manifestations Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin
250.81 250.82
113
250.83 250.9 250.90
Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Uncontrolled Diabetes With Unspecified Complication Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Uncontrolled Polyneuropathy In Diabetes Diabetic Retinopathy Background Diabetic Retinopathy Proliferative Diabetic Retinopathy Nonproliferative diabetic retinopathy NOS Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic retinopathy Diabetic macular edema Diabetic Cataract Diabetes Mellitus Complicating Pregnancy, Childbirth, Or The Puerperium Diabetes Mellitus Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care Diabetes Mellitus Of Mother, With Delivery
They have an active diagnosis of polycystic ovaries 256.4 Polycystic Ovaries Diagnosis Active of gestational diabetes 648.8 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium 648.80 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care 648.81 Abnormal Glucose Tolerance Of Mother, With Delivery 648.82 Abnormal Glucose Tolerance Of Mother, With Delivery, With Mention Of
114
648.83 648.84
Postpartum Complication Abnormal Glucose Tolerance Of Mother, Antepartum Abnormal Glucose Tolerance Of Mother, Postpartum
Diagnosis Active of Steroid induced diabetes 249 Secondary Diabetes Mellitus 249.0 Secondary diabetes mellitus without mention of complication 249.00 Secondary diabetes mellitus without mention of complication, not stated as uncontrolled or unspecified 249.01 Secondary diabetes mellitus without mention of complication, uncontrolled 249.1 Secondary diabetes mellitus without mention of complication 249.10 Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified 249.11 Secondary diabetes mellitus with ketoacidosis, uncontrolled 249.2 Secondary diabetes mellitus with hyperosmolarity 249.20 Secondary diabetes mellitus with hyperosmolarity, not stated as uncontrolled, or unspecified 249.21 Secondary diabetes mellitus with hyperosmolarity, uncontrolled 249.3 Secondary diabetes mellitus with other coma 249.30 Secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified 249.31 Secondary diabetes mellitus with other coma, uncontrolled 249.4 Secondary diabetes mellitus with renal manifestations 249.40 Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified 249.41 Secondary diabetes mellitus with renal manifestations, uncontrolled 249.5 Secondary diabetes mellitus with ophthalmic manifestations 249.50 Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified 249.51 Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled 249.6, Secondary diabetes mellitus with neurological manifestations 249.60 Secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or unspecified 249.61 Secondary diabetes mellitus with neurological manifestations, uncontrolled 249.7 Secondary diabetes mellitus with peripheral circulatory disorders 249.70 Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or unspecified 249.71 Secondary diabetes mellitus with peripheral circulatory disorders, uncontrolled 249.8 Secondary diabetes mellitus with other specified manifestations 249.80 Secondary diabetes mellitus with other specified manifestations, not stated as uncontrolled, or unspecified 249.81 Secondary diabetes mellitus with other specified manifestations, uncontrolled 249.9 Secondary diabetes mellitus with unspecified complication 249.90 Secondary diabetes mellitus with unspecified complication, not stated as uncontrolled, or unspecified 249.91 Secondary diabetes mellitus with unspecified complication, uncontrolled 251.8 Other Specified Disorders Of Pancreatic Internal Secretion 115
Encounter Codes Accepted for appointment outside of Physician using MU: Encount CPT Encounter Encounter Encounter CPT CPT CPT er Acute ED Non-Acute Outpatient Inpatient Inpatient Opthamolo gical services 99221 1ST 99281 EMER DEPT 99304 1ST NF CARE 92002 OPH HOSP SELF PR D E/M LW MEDICAL CARE LIMITED/MIN SEVERITY XM&EVAL PR D 30 OR INTRM MIN NEW PT 99222 1ST HOSP CARE PR D 50 MIN 99282 EMER DEPT LOW TO MODERATE SEVERITY 99305 1ST NF CARE PR D E/M MOD SEVERITY 92004 OPH MEDICAL XM&EVAL COMPRE NEW PT 1+ VST OPH MEDICAL XM&EVAL INTRM EST PT OPH MEDICAL XM&EVAL COMPRE EST PT 1+ VST
99223
1ST HOSP CARE PR D 70 MIN SBSQ HOSP CARE PR D 15 MIN
99283
EMER DEPT MODERATE SEVERITY
99306
1ST NF CARE PR D E/M HI SEVERITY
92012
99231
99284
EMER DEPT HI SEVERITY&U RGENT EVAL
99307
SBSQ NF CARE PR D E/M STABLE
92014
99232
SBSQ HOSP CARE PR D 25 MIN SBSQ HOSP CARE PR D 35 MIN HOSP DSCHRG D MGMT 30 MIN/<
99285
EMER DEPT HIGH SEVERITY&T HREAT FUNCJ
99308
SBSQ NF CARE PR D E/M MINOR COMPLCTJ
99233
99309
SBSQ NF CARE PR D E/M NEW PROBLEM
99238
99310
SBSQ NF CARE PR D E/M UNSTABLE/N EW PROBLEM
122
99239
HOSP DSCHRG D MGMT > 30 MIN 1ST INPT CONSLT J 20 MIN 1ST INPT CONSLT J 40 MIN 1ST INPT CONSLT J 55 MIN 1ST INPT CONSLT J 80 MIN 1ST INPT CONSLT J 110 MIN
99315
NF DSCHRG D MGMT 30 MIN/<
99251 99252
99316
NF DSCHRG D MGMT > 30 MIN
99253
99318
E/M PT INVG ANNUAL NF ASSMT
99254
99324
DOM/RHOME LW SEVERITY
99255
99325
DOM/RHOME E/M NEW PT MOD SEVERITY
99326
DOM/RHOME E/M NEW PT MOD HI SEVERITY DOM/RHOME E/M NEW PT HI SEVERITY DOM/RHOME E/M NEW PT SIGNIFICANT NEW PROBLEM DOM/RHOME E/M
99327
99328
99334
123
EST PT SELFLMTD/MINOR 99335 DOM/RHOME E/M EST PT LW MOD SEVERITY DOM/RHOME E/M EST PT SIGNIFICANT NEW PROBLEM
99337
124
Diabetes: HbA1c Poor Control (NQF 0059) (Additional Measure - MENU)
Description: The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had HbA1c >9.0%. Diagnosis – Diabetes ICD-9 Description 250 Diabetes Mellitus 250.0 Diabetes Mellitus Without Mention Of Complication 250.00 Diabetes Mellitus Without Mention Of Complication, type two or unspecified type, not stated as uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin, 250.01 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], not stated as uncontrolled, 250.02 Diabetes Mellitus Without Mention Of Complication, Type two or unspecified type, uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.03 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], uncontrolled 250.10 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.11 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type] Not Stated As Uncontrolled 250.12 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.13 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type], Uncontrolled 250.20 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.21 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Not Stated As Uncontrolled 250.22 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.23 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Uncontrolled 250.30 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.31 Diabetes Mellitus With Other Coma, Type One [juvenile], Not Stated As Uncontrolled 250.32 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.33 Diabetes Mellitus With Other Coma, Type One [juvenile], Uncontrolled 250.4 Diabetes With Renal Manifestations 250.40 Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients,
125
250.41 250.42
250.43 250.50
250.51 250.52
250.53 250.60
250.61 250.62
250.63 250.7 250.70
250.71 250.72
250.73 250.8 250.80
250.81 250.82
250.83
even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type]. Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Not Stated As Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Uncontrolled Diabetes With Peripheral Circulatory Disorders Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Uncontrolled Diabetes With Other Specified Manifestations Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile
type], Uncontrolled Diabetes With Unspecified Complication Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Uncontrolled Polyneuropathy In Diabetes Diabetic Retinopathy Background Diabetic Retinopathy Proliferative Diabetic Retinopathy Nonproliferative diabetic retinopathy NOS Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic retinopathy Diabetic macular edema Diabetic Cataract Diabetes Mellitus Complicating Pregnancy, Childbirth, Or The Puerperium Diabetes Mellitus Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care Diabetes Mellitus Of Mother, With Delivery
Active diagnosis of polycystic ovaries ICD-9 Description 256.4 Polycystic Ovaries Diagnosis Active of gestational diabetes ICD-9 Description 648.8 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium 648.80 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care 648.81 Abnormal Glucose Tolerance Of Mother, With Delivery 648.82 Abnormal Glucose Tolerance Of Mother, With Delivery, With Mention Of Postpartum Complication 648.83 Abnormal Glucose Tolerance Of Mother, Antepartum 648.84 Abnormal Glucose Tolerance Of Mother, Postpartum Diagnosis Active of Steroid induced diabetes ICD-9 Description 249 Secondary Diabetes Mellitus 249.0 Secondary diabetes mellitus without mention of complication 249.00 Secondary diabetes mellitus without mention of complication, not stated as uncontrolled or unspecified 249.01 Secondary diabetes mellitus without mention of complication, uncontrolled 127
Secondary diabetes mellitus without mention of complication Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with ketoacidosis, uncontrolled Secondary diabetes mellitus with hyperosmolarity Secondary diabetes mellitus with hyperosmolarity, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with hyperosmolarity, uncontrolled Secondary diabetes mellitus with other coma Secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with other coma, uncontrolled Secondary diabetes mellitus with renal manifestations Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with renal manifestations, uncontrolled Secondary diabetes mellitus with ophthalmic manifestations Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled Secondary diabetes mellitus with neurological manifestations Secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with neurological manifestations, uncontrolled Secondary diabetes mellitus with peripheral circulatory disorders Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with peripheral circulatory disorders, uncontrolled Secondary diabetes mellitus with other specified manifestations Secondary diabetes mellitus with other specified manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with other specified manifestations, uncontrolled Secondary diabetes mellitus with unspecified complication Secondary diabetes mellitus with unspecified complication, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with unspecified complication, uncontrolled Other Specified Disorders Of Pancreatic Internal Secretion Poisoning By Adrenal Cortical Steroids
HbA1c test LOINC 17856-6 4548-4 4549-2
Description Hemoglobin A1c/Hemoglobin.total in Blood by HPLC Hemoglobin A1c/Hemoglobin.total in Blood Hemoglobin A1c/Hemoglobin.total in Blood by Electrophoresis
Medications Ordered, Dispensed, Active RxNORM Description Alph-glucosides 128
Encounter Codes Accepted for appointment outside of Physician using MU: Encount CPT Encounter Encounter Encounter CPT CPT CPT er Acute ED Non-Acute Outpatient Inpatient Inpatient Opthamolog ical services 99221 1ST HOSP CARE PR D 30 MIN 99222 1ST HOSP CARE PR D 50 MIN 99281 EMER DEPT SELF LIMITED/MIN OR 99304 1ST NF CARE PR D E/M LW SEVERITY 92002 OPH MEDICAL XM&EVAL INTRM NEW PT OPH MEDICAL XM&EVAL COMPRE NEW PT 1+ VST OPH MEDICAL XM&EVAL INTRM EST PT
99282
EMER DEPT LOW TO MODERATE SEVERITY
99305
1ST NF CARE PR D E/M MOD SEVERITY
92004
99223 1ST HOSP CARE PR D 70 MIN 134
99283
EMER DEPT MODERATE SEVERITY
99306
1ST NF CARE PR D E/M HI SEVERITY
92012
99231 SBSQ HOSP CARE PR D 15 MIN
99284
EMER DEPT HI SEVERITY&U RGENT EVAL
99307
SBSQ NF CARE PR D E/M STABLE
92014
OPH MEDICAL XM&EVAL COMPRE EST PT 1+ VST
99232 SBSQ HOSP CARE PR D 25 MIN 99233 SBSQ HOSP CARE PR D 35 MIN 99238 HOSP DSCHRG D MGMT 30 MIN/<
99285
EMER DEPT HIGH SEVERITY&T HREAT FUNCJ
99308
SBSQ NF CARE PR D E/M MINOR COMPLCTJ
99309
SBSQ NF CARE PR D E/M NEW PROBLEM
99310
SBSQ NF CARE PR D E/M UNSTABLE/N EW PROBLEM NF DSCHRG D MGMT 30 MIN/<
99239 HOSP DSCHRG D MGMT > 30 MIN 99251 1ST 99252 INPT CONSLT J 20 MIN 1ST INPT CONSLT J 40 MIN 99253 1ST INPT CONSLT J 55 MIN 99254 1ST INPT CONSLT J 80 MIN 135
99315
99316
NF DSCHRG D MGMT > 30 MIN
99318
E/M PT INVG ANNUAL NF ASSMT
99324
DOM/RHOME LW SEVERITY
99255 1ST INPT CONSLT J 110 MIN
99325
DOM/RHOME E/M NEW PT MOD SEVERITY DOM/RHOME E/M NEW PT MOD HI SEVERITY DOM/RHOME E/M NEW PT HI SEVERITY DOM/RHOME E/M NEW PT SIGNIFICANT NEW PROBLEM DOM/RHOME E/M EST PT SELFLMTD/MINOR DOM/RHOME E/M EST PT LW MOD SEVERITY DOM/RHOME E/M EST PT SIGNIFICANT NEW PROBLEM
99326
99327
99328
99334
99335
99337
136
Diabetes: Blood Pressure Management (NQF 0061) (Additional Measure MENU)
Description: The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had BP <140/90 mmHg. Active diagnosis: Diabetes ICD Description 250 Diabetes Mellitus 250.0 Diabetes Mellitus Without Mention Of Complication 250.00 Diabetes Mellitus Without Mention Of Complication, type two or unspecified type, not stated as uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin, 250.01 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], not stated as uncontrolled, 250.02 Diabetes Mellitus Without Mention Of Complication, Type two or unspecified type, uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.03 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], uncontrolled 250.10 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.11 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type] Not Stated As Uncontrolled 250.12 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.13 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type], Uncontrolled 250.20 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.21 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Not Stated As Uncontrolled 250.22 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.23 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Uncontrolled 250.30 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.31 Diabetes Mellitus With Other Coma, Type One [juvenile], Not Stated As Uncontrolled 250.32 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.33 Diabetes Mellitus With Other Coma, Type One [juvenile], Uncontrolled 250.4 Diabetes With Renal Manifestations 250.40 Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, 137
250.41 250.42
250.43 250.50
250.51 250.52
250.53 250.60
250.61 250.62
250.63 250.7 250.70
250.71 250.72
250.73 250.8 250.80
Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type]. Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Not Stated As Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Uncontrolled Diabetes With Peripheral Circulatory Disorders Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Uncontrolled Diabetes With Other Specified Manifestations Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin
250.81 250.82
138
250.83 250.9 250.90
Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Uncontrolled Diabetes With Unspecified Complication Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Uncontrolled Polyneuropathy In Diabetes Diabetic Retinopathy Background Diabetic Retinopathy Proliferative Diabetic Retinopathy Nonproliferative diabetic retinopathy NOS Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic retinopathy Diabetic macular edema Diabetic Cataract Diabetes Mellitus Complicating Pregnancy, Childbirth, Or The Puerperium Diabetes Mellitus Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care Diabetes Mellitus Of Mother, With Delivery
Active diagnosis of polycystic ovaries ICD-9 Description 256.4 Polycystic Ovaries Active diagnosis of gestational diabetes ICD-9 Description 648.8 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium 648.80 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care 648.81 Abnormal Glucose Tolerance Of Mother, With Delivery 648.82 Abnormal Glucose Tolerance Of Mother, With Delivery, With Mention Of Postpartum Complication 648.83 Abnormal Glucose Tolerance Of Mother, Antepartum 648.84 Abnormal Glucose Tolerance Of Mother, Postpartum
Active diagnosis of Steroid induced diabetes ICD-9 Description 249 Secondary Diabetes Mellitus 249.0 Secondary diabetes mellitus without mention of complication 139
Secondary diabetes mellitus without mention of complication, not stated as uncontrolled or unspecified Secondary diabetes mellitus without mention of complication, uncontrolled Secondary diabetes mellitus without mention of complication Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with ketoacidosis, uncontrolled Secondary diabetes mellitus with hyperosmolarity Secondary diabetes mellitus with hyperosmolarity, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with hyperosmolarity, uncontrolled Secondary diabetes mellitus with other coma Secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with other coma, uncontrolled Secondary diabetes mellitus with renal manifestations Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with renal manifestations, uncontrolled Secondary diabetes mellitus with ophthalmic manifestations Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled Secondary diabetes mellitus with neurological manifestations Secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with neurological manifestations, uncontrolled Secondary diabetes mellitus with peripheral circulatory disorders Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with peripheral circulatory disorders, uncontrolled Secondary diabetes mellitus with other specified manifestations Secondary diabetes mellitus with other specified manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with other specified manifestations, uncontrolled Secondary diabetes mellitus with unspecified complication Secondary diabetes mellitus with unspecified complication, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with unspecified complication, uncontrolled Other Specified Disorders Of Pancreatic Internal Secretion Poisoning By Adrenal Cortical Steroids
Encounter Codes Accepted for appointment outside of Physician using MU: Encount CPT Encounter ED Encounter Encounter CPT CPT CPT er Acute Non-Acute Outpatient Inpatient Inpatient Opthamolog ical services 99221 1ST HOSP CARE PR D 30 MIN 99222 1ST HOSP CARE PR D 50 MIN 99281 EMER DEPT SELF LIMITED/MINO R 99304 1ST NF CARE PR D E/M LW SEVERITY 92002 OPH MEDICAL XM&EVAL INTRM NEW PT OPH MEDICAL XM&EVAL COMPRE NEW PT 1+ VST OPH MEDICAL XM&EVAL INTRM EST PT OPH MEDICAL XM&EVAL COMPRE EST PT 1+ VST
99282
EMER DEPT LOW TO MODERATE SEVERITY
99305
1ST NF CARE PR D E/M MOD SEVERITY
92004
99223 1ST HOSP CARE PR D 70 MIN 99231 SBSQ HOSP CARE PR D 15 MIN
99283
EMER DEPT MODERATE SEVERITY
99306
1ST NF CARE PR D E/M HI SEVERITY
92012
99284
EMER DEPT HI SEVERITY&UR GENT EVAL
99307
SBSQ NF CARE PR D E/M STABLE
92014
99232 SBSQ HOSP CARE PR D 25 MIN 99233 SBSQ HOSP CARE PR D 35 MIN 99238 HOSP DSCHRG D MGMT 30 MIN/<
99285
EMER DEPT HIGH SEVERITY&TH REAT FUNCJ
99308
SBSQ NF CARE PR D E/M MINOR COMPLCTJ
99309
SBSQ NF CARE PR D E/M NEW PROBLEM
99310
SBSQ NF CARE PR D E/M UNSTABLE/ NEW PROBLEM
147
99239 HOSP DSCHRG D MGMT > 30 MIN 99251 1ST 99252 INPT CONSLT J 20 MIN 1ST INPT CONSLT J 40 MIN 99253 1ST INPT CONSLT J 55 MIN 99254 1ST INPT CONSLT J 80 MIN 99255 1ST INPT CONSLT J 110 MIN
99315
NF DSCHRG D MGMT 30 MIN/< NF DSCHRG D MGMT > 30 MIN
99316
99318
E/M PT INVG ANNUAL NF ASSMT DOM/RHOME LW SEVERITY
99324
99325
DOM/RHOME E/M NEW PT MOD SEVERITY DOM/RHOME E/M NEW PT MOD HI SEVERITY DOM/RHOME E/M NEW PT HI SEVERITY DOM/RHOME E/M NEW PT SIGNIFICA NT NEW PROBLEM DOM/R-
99326
99327
99328
99334 148
HOME E/M EST PT SELFLMTD/MIN OR 99335 DOM/RHOME E/M EST PT LW MOD SEVERITY DOM/RHOME E/M EST PT SIGNIFICA NT NEW PROBLEM
99337
149
Diabetes: Urine Screening (NQF 0062) (Additional Measure - MENU)
Description: This measure facilitates the prevention and long-term management of kidney disease (Real-Time Rule). Diagnosis Active – Diagnosis/Condition/Problem ICD-9Description CM 250 Diabetes Mellitus 250.0 Diabetes Mellitus Without Mention Of Complication 250.00 Diabetes Mellitus Without Mention Of Complication, type two or unspecified type, not stated as uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin, 250.01 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], not stated as uncontrolled, 250.02 Diabetes Mellitus Without Mention Of Complication, Type two or unspecified type, uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.03 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], uncontrolled 250.10 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.11 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type] Not Stated As Uncontrolled 250.12 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.13 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type], Uncontrolled 250.20 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.21 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Not Stated As Uncontrolled 250.22 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.23 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Uncontrolled 250.30 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.31 Diabetes Mellitus With Other Coma, Type One [juvenile], Not Stated As Uncontrolled 250.32 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.33 Diabetes Mellitus With Other Coma, Type One [juvenile], Uncontrolled 250.4 Diabetes With Renal Manifestations 250.40 Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type,
150
250.41 250.42
250.43 250.50
250.51 250.52
250.53 250.60
250.61 250.62
250.63 250.7 250.70
250.71 250.72
250.73 250.8 250.80
250.81 250.82
Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type]. Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Not Stated As Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Uncontrolled Diabetes With Peripheral Circulatory Disorders Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Uncontrolled Diabetes With Other Specified Manifestations Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin
151
250.83 Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Uncontrolled 250.9 Diabetes With Unspecified Complication 250.90 Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin 250.91 Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Not Stated As Uncontrolled 250.92 Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin 250.93 Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Uncontrolled 357.2 Polyneuropathy In Diabetes 362.0 Diabetic Retinopathy 362.01 Background Diabetic Retinopathy 362.02 Proliferative Diabetic Retinopathy 362.03 Nonproliferative diabetic retinopathy NOS 362.04 Mild nonproliferative diabetic retinopathy 362.05 Moderate nonproliferative diabetic retinopathy 362.06 Severe nonproliferative diabetic retinopathy 362.07 Diabetic macular edema 366.41 Diabetic Cataract 648.0 Diabetes Mellitus Complicating Pregnancy, Childbirth, Or The Puerperium 648.00 Diabetes Mellitus Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care 648.01 Diabetes Mellitus Of Mother, With Delivery Diabetes mellitus complicating pregnancy, childbirth, or the puerperium, 648.02 delivered, with mention of postpartum complication Diabetes mellitus complicating pregnancy, childbirth, or the puerperium, 648.03 antepartum condition or complication Diabetes mellitus complicating pregnancy, childbirth, or the puerperium, 648.04 postpartum condition or complication Diagnosis Active – gestational diabetes ICD-9Description CM 648.8 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium 648.80 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care 648.81 Abnormal Glucose Tolerance Of Mother, With Delivery 648.82 Abnormal Glucose Tolerance Of Mother, With Delivery, With Mention Of Postpartum Complication 648.83 Abnormal Glucose Tolerance Of Mother, Antepartum 648.84 Abnormal Glucose Tolerance Of Mother, Postpartum Diagnosis Active – nephropathy ICD-9Description 152
CM 250.4 Diabetes with renal manifestations Diabetes mellitus with renal manifestations, type II or unspecified type, not 250.40 stated as uncontrolled Diabetes mellitus with renal manifestations, type I [juvenile type], not stated as 250.41 uncontrolled Diabetes mellitus with renal manifestations, type II or unspecified type, 250.42 uncontrolled 250.43 Diabetes mellitus with renal manifestations, type I [juvenile type], uncontrolled 403 Hypertensive chronic kidney disease 403.0 Hypertensive chronic kidney disease, malignant Hypertensive chronic kidney disease, malignant, with chronic kidney disease 403.00 stage I through stage IV, or unspecified Hypertensive chronic kidney disease, malignant, with chronic kidney disease 403.01 stage V or end stage renal disease 403.1 Hypertensive chronic kidney disease, benign Hypertensive chronic kidney disease, benign, with chronic kidney disease 403.10 stage I through stage IV, or unspecified Hypertensive chronic kidney disease, benign, with chronic kidney disease 403.11 stage V or end stage renal disease 403.9 Hypertensive chronic kidney disease, unspecified Hypertensive chronic kidney disease, unspecified, with chronic kidney disease 403.90 stage I through stage IV, or unspecified Hypertensive chronic kidney disease, unspecified, with chronic kidney disease 403.91 stage V or end stage renal disease 404 Hypertensive heart and chronic kidney disease 404.0 Hypertensive heart and chronic kidney disease, malignant Hypertensive heart and chronic kidney disease, malignant, without heart failure 404.00 and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, malignant, with heart failure 404.01 and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, malignant, without heart failure 404.02 and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, malignant, with heart failure 404.03 and with chronic kidney disease stage V or end stage renal disease 404.1 Hypertensive heart and chronic kidney disease, benign Hypertensive heart and chronic kidney disease, benign, without heart failure 404.10 and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, benign, with heart failure and 404.11 with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, benign, without heart failure 404.12 and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, benign, with heart failure and 404.13 chronic kidney disease stage V or end stage renal disease 404.9 Hypertensive heart and chronic kidney disease, unspecified Hypertensive heart and chronic kidney disease, unspecified, without heart 404.90 failure and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, unspecified, with heart failure 404.91 and with chronic kidney disease stage I through stage IV, or unspecified 153
Hypertensive heart and chronic kidney disease, unspecified, without heart 404.92 failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, with heart failure 404.93 and chronic kidney disease stage V or end stage renal disease 405.01 Malignant renovascular hypertension 405.91 Unspecified renovascular hypertension 580.0 Acute glomerulonephritis with lesion of proliferative glomerulonephritis 580.8 Acute glomerulonephritis with other specified pathological lesion in kidney 580.89 Acute glomerulonephritis with other specified pathological lesion in kidney 581 Nephrotic syndrome 581.1 Nephrotic syndrome with lesion of membranous glomerulonephritis 581.3 Nephrotic syndrome with lesion of minimal change glomerulonephritis 581.81 Nephrotic syndrome with lesion of minimal change glomerulonephritis 581.9 Nephrotic syndrome with unspecified pathological lesion in kidney 582 Chronic glomerulonephritis 582.0 Chronic glomerulonephritis with lesion of proliferative glomerulonephritis 582.1 Chronic glomerulonephritis with lesion of membranous glomerulonephritis Chronic glomerulonephritis with lesion of membranoproliferative 582.2 glomerulonephritis 582.8 Chronic glomerulonephritis with other specified pathological lesion in kidney 582.81 Chronic glomerulonephritis in diseases classified elsewhere 582.89 Chronic glomerulonephritis with other specified pathological lesion in kidney 582.9 Chronic glomerulonephritis with unspecified pathological lesion in kidney 583 Nephritis and nephropathy, not specified as acute or chronic 583.0 Nephritis and nephropathy, not specified as acute or chronic Nephritis and nephropathy, not specified as acute or chronic, with lesion of 583.1 membranous glomerulonephritis Nephritis and nephropathy, not specified as acute or chronic, with lesion of 583.2 membranoproliferative glomerulonephritis Nephritis and nephropathy, not specified as acute or chronic, with lesion of 583.4 rapidly progressive glomerulonephritis Nephritis and nephropathy, not specified as acute or chronic, with lesion of 583.6 renal cortical necrosis Nephritis and nephropathy, not specified as acute or chronic, with lesion of 583.7 renal medullary necrosis Nephritis and nephropathy, not specified as acute or chronic, with other 583.8 specified pathological lesion in kidney Nephritis and nephropathy, not specified as acute or chronic, in diseases 583.81 classified elsewhere Nephritis and nephropathy, not specified as acute or chronic, with other 583.89 specified pathological lesion in kidney Nephritis and nephropathy, not specified as acute or chronic, with unspecified 583.9 pathological lesion in kidney 584.5 Acute kidney failure with lesion of tubular necrosis 584.7 Acute kidney failure with lesion of renal medullary [papillary] necrosis 584.8 Acute kidney failure with other specified pathological lesion in kidney 584.9 Acute kidney failure, unspecified 585 Chronic kidney disease (CKD) 585.1 Chronic kidney disease, Stage I 154
Chronic kidney disease, Stage II (mild) Chronic kidney disease, Stage III (moderate) Chronic kidney disease, Stage IV (severe) Chronic kidney disease, Stage V End stage renal disease Chronic kidney disease, unspecified Renal failure, unspecified Renal sclerosis, unspecified Disorders resulting from impaired renal function Renal osteodystrophy Nephrogenic diabetes insipidus Other specified disorders resulting from impaired renal function Secondary hyperparathyroidism (of renal origin) Other specified disorders resulting from impaired renal function Unspecified disorder resulting from impaired renal function Renal agenesis and dysgenesis Cystic kidney disease Cystic kidney disease, unspecified Congenital single renal cyst Polycystic kidney, unspecified type Polycystic kidney, autosomal dominant Polycystic kidney, autosomal recessive Renal dysplasia Medullary cystic kidney Medullary sponge kidney Other specified cystic kidney disease Proteinuria Kidney replaced by transplant Postsurgical renal dialysis status Renal dialysis status Noncompliance with renal dialysis Encounter for dialysis and dialysis catheter care Encounter for extracorporeal dialysis Fitting and adjustment of extracorporeal dialysis catheter Fitting and adjustment of peritoneal dialysis catheter Encounter for adequacy testing for dialysis Encounter for adequacy testing for hemodialysis Encounter for adequacy testing for peritoneal dialysis Encounter for other dialysis
Diagnosis Active – polycystic ovaries ICD-9Description CM 256.4 Polycystic Ovaries
155
Diagnosis Active – steroid induced diabetes ICD-9Description CM 249 Secondary Diabetes Mellitus 249.0 Secondary diabetes mellitus without mention of complication 249.00 Secondary diabetes mellitus without mention of complication, not stated as uncontrolled or unspecified 249.01 Secondary diabetes mellitus without mention of complication, uncontrolled 249.1 Secondary diabetes mellitus without mention of complication 249.10 Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified 249.11 Secondary diabetes mellitus with ketoacidosis, uncontrolled 249.2 Secondary diabetes mellitus with hyperosmolarity 249.20 Secondary diabetes mellitus with hyperosmolarity, not stated as uncontrolled, or unspecified 249.21 Secondary diabetes mellitus with hyperosmolarity, uncontrolled 249.3 Secondary diabetes mellitus with other coma 249.30 Secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified 249.31 Secondary diabetes mellitus with other coma, uncontrolled 249.4 Secondary diabetes mellitus with renal manifestations 249.40 Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified 249.41 Secondary diabetes mellitus with renal manifestations, uncontrolled 249.5 Secondary diabetes mellitus with ophthalmic manifestations 249.50 Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified 249.51 Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled 249.6 Secondary diabetes mellitus with neurological manifestations 249.60 Secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or unspecified 249.61 Secondary diabetes mellitus with neurological manifestations, uncontrolled 249.7 Secondary diabetes mellitus with peripheral circulatory disorders 249.70 Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or unspecified 249.71 Secondary diabetes mellitus with peripheral circulatory disorders, uncontrolled 249.8 Secondary diabetes mellitus with other specified manifestations 249.80 Secondary diabetes mellitus with other specified manifestations, not stated as uncontrolled, or unspecified 249.81 Secondary diabetes mellitus with other specified manifestations, uncontrolled 249.9 Secondary diabetes mellitus with unspecified complication 249.90 Secondary diabetes mellitus with unspecified complication, not stated as uncontrolled, or unspecified 249.91 Secondary diabetes mellitus with unspecified complication, uncontrolled 251.8 Other Specified Disorders Of Pancreatic Internal Secretion 962.0 Poisoning by adrenal cortical steroids
156
Procedure Performed – nephropathy-related procedures CPT Description 36145 INTRO NDL/INTRACATH ARVEN SHUNT CREATED DIAL 36800 INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN 36810 INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL 36815 INSJ CANNULA HEMO OTH SPX ARVEN XTRNL REVJ/CLSR 36818 ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS 36819 ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS 36821 ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT 36831 THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF 36832 REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF 36833 REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF 50300 DON NFRCT FROM CDVR DON UNI/BI 50320 DON NFRCT OPN FROM LIV DON 50340 RCP NFRCT SPX 50360 RNL ALTRNSPLJ IMPLTJ GRF W/O RCP NFRCT 50365 RNL ALTRNSPLJ IMPLTJ GRF W/RCP NFRCT 50370 RMVL TRNSPLED RNL ALGRFT 50380 RNL AUTOTRNSPLJ RIMPLTJ KDN 90920 ESRD FULL MO 12-19 YR 90921 ESRD FULL MO 20 YR&> 90924 ESRD <FULL MO PR D 12-19YR 90925 ESRD < FULL MO PR D 20YR&> 90935 HEMO PX W/1 PHYS EVAL 90937 HEMO REPEATED EVAL +-REVJ DIAL RX 90940 HEMO ACCESS FLO STD 90945 DIAL OTH/THN HEMO 1 PHYS EVAL 90947 DIAL OTH/THN HEMO REPEATED PHYS EVALS 90957 ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/>VISITS 90958 ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS 90959 ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT 90960 ESRD RELATED SVC MONTHLY 20&> YR OLD 4/> VISITS 90961 ESRD RELATED SVC MONTHLY 20&> YR OLD 2/3 VISITS 90962 ESRD RELATED SVC MONTHLY 20&> YR OLD 1 VISIT 90965 ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD 90966 ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD 90969 ESRD RELATED SVC <FULL MONTH 12-19 YR OLD 90970 ESRD RELATED SVC <FULL MONTH 20&> YR OLD 90989 DIAL TRAINJ COMPLD COURSE 90993 DIAL TRAINJ COURSE X COMPLD PR SESS 90997 HEMOPRFJ 90999 UNLIS DIAL I/P/O/P 99512 HOME VST HEMO Laboratory Test Performed - nephropathy screening LOINC Description 11218-5 Microalbumin [Mass/volume] in Urine by Test strip 12842-1 Protein [Mass/volume] in 12 hour Urine
Albumin/Creatinine [Mass ratio] in 24 hour Urine Protein/Creatinine [Mass ratio] in 24 hour Urine Albumin/Creatinine [Molar ratio] in Urine Microalbumin [Mass/time] in 24 hour Urine Microalbumin [Mass/volume] in Urine Microalbumin/Creatinine [Mass ratio] in 24 hour Urine Microalbumin/Creatinine [Mass ratio] in Urine Albumin [Presence] in Urine Albumin [Mass/volume] in Urine Albumin [Mass/time] in 24 hour Urine Albumin renal clearance in 24 hour Protein [Mass/time] in 6 hour Urine Albumin/Creatinine [Presence] in Urine by Test strip Albumin [Mass/volume] in 24 hour Urine Protein [Mass/volume] in 24 hour Urine Protein [Mass/time] in 12 hour Urine Protein [Units/volume] in Urine Protein [Presence] in Urine Protein [Mass/volume] in Urine Protein [Mass/time] in 24 hour Urine Protein/Creatinine [Mass ratio] in Urine Microalbumin/Creatinine [Ratio] in Urine Microalbumin/Creatinine [Ratio] in Urine by Test strip Microalbumin [Mass/volume] in 24 hour Urine Protein [Presence] in 24 hour Urine by Test strip Albumin/Creatinine [Ratio] in Urine Protein [Mass] in unspecified time Urine Protein/Creatinine [Ratio] in Urine Protein [Mass/volume] in unspecified time Urine Protein/Creatinine [Ratio] in 24 hour Urine Protein [Mass/time] in 12 hour Urine --resting Protein [Mass/time] in 12 hour Urine –upright Microalbumin [Mass/volume] in 4 hour Urine Microalbumin [Mass/time] in 4 hour Urine Microalbumin [Mass/time] in 12 hour Urine Microalbumin/Creatinine [Mass ratio] in 12 hour Urine Microalbumin/Protein.total in 24 hour Urine Microalbumin [Mass/time] in unspecified time Urine Albumin [Presence] in Urine by Test strip Protein [Mass/time] in 1 hour Urine Microalbumin [Mass/volume] in 24 hour Urine by Detection limit <= 1.0 mg/L
1ST NF CARE PR D E/M HI SEVERITY SBSQ NF CARE PR D E/M STABLE SBSQ NF CARE PR D E/M MINOR COMPLCTJ SBSQ NF CARE PR D E/M NEW PROBLEM SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM NF DSCHRG D MGMT 30 MIN/< NF DSCHRG D MGMT > 30 MIN E/M PT INVG ANNUAL NF ASSMT DOM/R-HOME LW SEVERITY DOM/R-HOME E/M NEW PT MOD SEVERITY DOM/R-HOME E/M NEW PT MOD HI SEVERITY DOM/R-HOME E/M NEW PT HI SEVERITY DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM DOM/R-HOME E/M EST PT SELF-LMTD/MINOR DOM/R-HOME E/M EST PT LW MOD SEVERITY DOM/R-HOME E/M EST PT MOD HI SEVERITY DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM
Encounter – outpatient - opthamological services CPT Description 92002 OPH MEDICAL XM&EVAL INTRM NEW PT 92004 OPH MEDICAL XM&EVAL COMPRE NEW PT 1+ VST 92012 OPH MEDICAL XM&EVAL INTRM EST PT 92014 OPH MEDICAL XM&EVAL COMPRE EST PT 1+ VST
169
Diabetes: LDL Management & Control (NQF 0064) (Additional Measure MENU)
Description: The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had LDL‐C <100mg/dL. Active diagnosis: Diabetes ICD-9 Description 250 Diabetes Mellitus 250.0 Diabetes Mellitus Without Mention Of Complication 250.00 Diabetes Mellitus Without Mention Of Complication, type two or unspecified type, not stated as uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin, 250.01 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], not stated as uncontrolled, 250.02 Diabetes Mellitus Without Mention Of Complication, Type two or unspecified type, uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.03 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], uncontrolled 250.10 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.11 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type] Not Stated As Uncontrolled 250.12 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.13 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type], Uncontrolled 250.20 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.21 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Not Stated As Uncontrolled 250.22 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.23 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Uncontrolled 250.30 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.31 Diabetes Mellitus With Other Coma, Type One [juvenile], Not Stated As Uncontrolled 250.32 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.33 Diabetes Mellitus With Other Coma, Type One [juvenile], Uncontrolled 250.4 Diabetes With Renal Manifestations 170
250.40
250.41 250.42
250.43 250.50
250.51 250.52
250.53 250.60
250.61 250.62
250.63 250.7 250.70
250.71 250.72
250.73 250.8 250.80
Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type]. Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Not Stated As Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Uncontrolled Diabetes With Peripheral Circulatory Disorders Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Uncontrolled Diabetes With Other Specified Manifestations Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients,
250.81 250.82
171
250.83 250.9 250.90
even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Uncontrolled Diabetes With Unspecified Complication Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Uncontrolled Polyneuropathy In Diabetes Diabetic Retinopathy Background Diabetic Retinopathy Proliferative Diabetic Retinopathy Nonproliferative diabetic retinopathy NOS Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic retinopathy Diabetic macular edema Diabetic Cataract Diabetes Mellitus Complicating Pregnancy, Childbirth, Or The Puerperium Diabetes Mellitus Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care Diabetes Mellitus Of Mother, With Delivery
Active diagnosis of polycystic ovaries ICD-9 Description 256.4 Polycystic Ovaries Actice Diagnosis of gestational diabetes ICD-9 Description 648.8 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium 648.80 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care 648.81 Abnormal Glucose Tolerance Of Mother, With Delivery 648.82 Abnormal Glucose Tolerance Of Mother, With Delivery, With Mention Of Postpartum Complication 648.83 Abnormal Glucose Tolerance Of Mother, Antepartum 648.84 Abnormal Glucose Tolerance Of Mother, Postpartum Active Diagnosis of Steroid induced diabetes ICD-9 Description 249 Secondary Diabetes Mellitus 249.0 Secondary diabetes mellitus without mention of complication 172
Secondary diabetes mellitus without mention of complication, not stated as uncontrolled or unspecified Secondary diabetes mellitus without mention of complication, uncontrolled Secondary diabetes mellitus without mention of complication Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with ketoacidosis, uncontrolled Secondary diabetes mellitus with hyperosmolarity Secondary diabetes mellitus with hyperosmolarity, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with hyperosmolarity, uncontrolled Secondary diabetes mellitus with other coma Secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with other coma, uncontrolled Secondary diabetes mellitus with renal manifestations Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with renal manifestations, uncontrolled Secondary diabetes mellitus with ophthalmic manifestations Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled Secondary diabetes mellitus with neurological manifestations Secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with neurological manifestations, uncontrolled Secondary diabetes mellitus with peripheral circulatory disorders Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with peripheral circulatory disorders, uncontrolled Secondary diabetes mellitus with other specified manifestations Secondary diabetes mellitus with other specified manifestations, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with other specified manifestations, uncontrolled Secondary diabetes mellitus with unspecified complication Secondary diabetes mellitus with unspecified complication, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with unspecified complication, uncontrolled Other Specified Disorders Of Pancreatic Internal Secretion Poisoning By Adrenal Cortical Steroids
Description Cholesterol in LDL [Un ts/volume] in Serum or Plasma by Electrophoresis Cholesterol in LDL [Mass/volume] in Serum or Plasma by calculation Cholesterol in LDL [Mass/volume] in Serum or Plasma ltracentrifugate Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay Cholesterol in LDL [Mass/volume] in Serum or Plasma Cholesterol in LDL [Moles/volume] in Serum or Plasma by calculation Cholesterol in LDL [Mass/volume] in Serum or Plasma by Electrophoresis Cholesterol.in LDL (real) [Mass/volume] in Serum or Plasma by VAP Cholesterol in LDL [Moles/volume] in Serum or Plasma
Encounter Codes Accepted for appointment outside of Physician using MU: Encount CPT Encounter ED Encounter Encounter CPT CPT CPT er Acute Non-Acute Outpatient Inpatient Inpatient Opthamolog ical services 99221 1ST HOSP CARE PR D 30 MIN 99222 1ST 99281 EMER DEPT SELF LIMITED/MINO R 99304 1ST NF CARE PR D E/M LW SEVERITY 92002 OPH MEDICAL XM&EVAL INTRM NEW PT OPH
99282
EMER DEPT
99305
1ST NF
92004
179
HOSP CARE PR D 50 MIN
LOW TO MODERATE SEVERITY
CARE PR D E/M MOD SEVERITY
MEDICAL XM&EVAL COMPRE NEW PT 1+ VST 92012 OPH MEDICAL XM&EVAL INTRM EST PT OPH MEDICAL XM&EVAL COMPRE EST PT 1+ VST
99223 1ST HOSP CARE PR D 70 MIN 99231 SBSQ HOSP CARE PR D 15 MIN
99283
EMER DEPT MODERATE SEVERITY
99306
1ST NF CARE PR D E/M HI SEVERITY
99284
EMER DEPT HI SEVERITY&UR GENT EVAL
99307
SBSQ NF CARE PR D E/M STABLE
92014
99232 SBSQ HOSP CARE PR D 25 MIN 99233 SBSQ HOSP CARE PR D 35 MIN 99238 HOSP DSCHRG D MGMT 30 MIN/<
99285
EMER DEPT HIGH SEVERITY&TH REAT FUNCJ
99308
SBSQ NF CARE PR D E/M MINOR COMPLCTJ
99309
SBSQ NF CARE PR D E/M NEW PROBLEM
99310
SBSQ NF CARE PR D E/M UNSTABLE/ NEW PROBLEM NF DSCHRG D MGMT 30 MIN/<
99239 HOSP DSCHRG D MGMT > 30 MIN 99251 1ST 99252 INPT CONSLT J 20 MIN 1ST INPT CONSLT 180
99315
99316
NF DSCHRG D MGMT > 30 MIN
J 40 MIN 99253 1ST INPT CONSLT J 55 MIN 99254 1ST INPT CONSLT J 80 MIN 99255 1ST INPT CONSLT J 110 MIN 99318 E/M PT INVG ANNUAL NF ASSMT DOM/RHOME LW SEVERITY
99324
99325
DOM/RHOME E/M NEW PT MOD SEVERITY DOM/RHOME E/M NEW PT MOD HI SEVERITY DOM/RHOME E/M NEW PT HI SEVERITY DOM/RHOME E/M NEW PT SIGNIFICAN T NEW PROBLEM DOM/RHOME E/M EST PT SELFLMTD/MINO R DOM/RHOME E/M EST PT LW MOD SEVERITY
99326
99327
99328
99334
99335
181
Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD (NQF 0067) (Additional Measure - MENU)
Description: Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed oral antiplatelet therapy. Active diagnosis of coronary artery disease - Enter in SOAP Note or Past Medical History ICD-9 Description 410 Acute myocardial infarction 410.01 Acute myocardial infarction, of anterolateral wall, initial episode of care 410.02 Acute myocardial infarction, of anterolateral wall, subsequent episode of care 410.1 Acute myocardial infarction, of other anterior wall 410.11 Acute myocardial infarction, of other anterior wall, initial episode of care 410.12 Acute myocardial infarction, of other anterior wall, subsequent episode of care 410.2 Acute myocardial infarction, of inferolateral wall 410.21 Acute myocardial infarction, of inferolateral wall, initial episode of care 410.22 Acute myocardial infarction, of inferolateral wall, subsequent episode of care 410.3 Acute myocardial infarction, of inferoposterior wall 410.31 Acute myocardial infarction, of inferoposterior wall, initial episode of care Acute myocardial infarction, of inferoposterior wall, subsequent episode of 410.32 care 410.4 Acute myocardial infarction, of other inferior wall 410.41 Acute myocardial infarction, of other inferior wall, initial episode of care 410.42 Acute myocardial infarction, of other inferior wall, subsequent episode of care 410.5 Acute myocardial infarction, of other lateral wall 410.51 Acute myocardial infarction, of other lateral wall, initial episode of care 410.52 Acute myocardial infarction, of other lateral wall, subsequent episode of care 410.6 Acute myocardial infarction, true posterior wall infarction Acute myocardial infarction, true posterior wall infarction, initial episode of 410.61 care Acute myocardial infarction, true posterior wall infarction, subsequent episode 410.62 of care 410.7 Acute myocardial infarction, subendocardial infarction 410.71 Acute myocardial infarction, subendocardial infarction, initial episode of care Acute myocardial infarction, subendocardial infarction, subsequent episode of 410.72 care 410.8 Acute myocardial infarction, of other specified sites 410.81 Acute myocardial infarction, of other specified sites, initial episode of care Acute myocardial infarction, of other specified sites, subsequent episode of 410.82 care 410.9 Acute myocardial infarction, unspecified site 410.91 Acute myocardial infarction, unspecified site, initial episode of care 410.92 Acute myocardial infarction, unspecified site, subsequent episode of care 411 Other acute and subacute forms of ischemic heart disease 411.1 Intermediate coronary syndrome 411.81 Acute coronary occlusion without myocardial infarction 411.89 Other acute and subacute forms of ischemic heart disease 412 Old myocardial infarction
Angina pectoris Prinzmetal angina Other and unspecified angina pectoris Other forms of chronic ischemic heart disease Coronary atherosclerosis of native coronary artery Coronary atherosclerosis of autologous vein bypass graft Coronary atherosclerosis of nonautologous biological bypass graft Coronary atherosclerosis of artery bypass graft Coronary atherosclerosis of unspecified type of bypass graft Coronary atherosclerosis of native coronary artery of transplanted heart Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart Other specified forms of chronic ischemic heart disease Chronic ischemic heart disease, unspecified Postsurgical aortocoronary bypass status Percutaneous transluminal coronary angioplasty, postsurgical status
Diagnosis of bleeding coagulation disorders ICD-9 Description 286 Coagulation defects 286.1 Congenital factor IX disorder 286.2 286.3 286.4 286.5 286.6 286.7 286.9 287 287.1 287.3 287.31 287.32 287.33 287.39 287.4 287.5 287.8 287.9 289.81 289.82 289.84 289.9 Congenital factor XI deficiency Congenital deficiency of other clotting factors von Willebrand's disease Hemorrhagic disorder due to intrinsic circulating anticoagulants Defibrination syndrome Acquired coagulation factor deficiency Other and unspecified coagulation defects Purpura and other hemorrhagic conditions Qualitative platelet defects Primary thrombocytopenia Immune thrombocytopenic purpura Evans' syndrome Congenital and hereditary thrombocytopenic purpura Other primary thrombocytopenia Secondary thrombocytopenia Thrombocytopenia, unspecified Other specified hemorrhagic conditions Unspecified hemorrhagic conditions Primary hypercoagulable state Secondary hypercoagulable state Heparin-induced thrombocytopenia (HIT) Unspecified diseases of blood and blood-forming organs
Encounter (nursing facility) - Enter in past medical history CPT Description 99304 1ST NF CARE PR D E/M LW SEVERITY 99305 1ST NF CARE PR D E/M MOD SEVERITY 99306 1ST NF CARE PR D E/M HI SEVERITY 99307 SBSQ NF CARE PR D E/M STABLE 99308 SBSQ NF CARE PR D E/M MINOR COMPLCTJ 99309 SBSQ NF CARE PR D E/M NEW PROBLEM 99310 SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM Encounter (inpatient discharge) – Enter in past medical history CPT Description 99238 HOSP DSCHRG D MGMT 30 MIN/< 99239 HOSP DSCHRG D MGMT > 30 MIN
187
Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic (NQF 0068) (Additional Measure - MENU)
Description: This measure facilitates long-term management of IVD through aspirin or another anti-thrombotic to prevent CHD (Real-Time Rule). Active Diagnosis of Acute Myocardial Infarction ICD-9Description CM 410.01 Acute myocardial infarction, of anterolateral wall, initial episode of care 410.11 Acute myocardial infarction, of other anterior wall, initial episode of care 410.21 Acute myocardial infarction, of inferolateral wall, initial episode of care 410.31 Acute myocardial infarction, of inferoposterior wall, initial episode of care 410.41 Acute myocardial infarction, of other inferior wall, initial episode of care 410.51 Acute myocardial infarction, of other lateral wall, initial episode of care Acute myocardial infarction, true posterior wall infarction, initial episode of 410.61 care 410.71 Acute myocardial infarction, subendocardial infarction, initial episode of care 410.81 Acute myocardial infarction, of other specified sites, initial episode of care 410.91 Acute myocardial infarction, unspecified site, initial episode of care Active Diagnosis of Ischemic Vascular Disease ICD-9Description CM 434.00 Cerebral thrombosis, without mention of cerebral infarction 411.0 Postmyocardial infarction syndrome 411.1 Intermediate coronary syndrome 411.81 Acute coronary occlusion without myocardial infarction 411.89 Other acute and subacute forms of ischemic heart disease 413.0 Angina decubitus 413.1 Prinzmetal angina 413.9 Other and unspecified angina pectoris 414.00 Coronary atherosclerosis of unspecified type of vessel, native or graft 414.01 Coronary atherosclerosis of native coronary artery 414.02 Coronary atherosclerosis of autologous vein bypass graft 414.03 Coronary atherosclerosis of nonautologous biological bypass graft 414.04 Coronary atherosclerosis of artery bypass graft 414.05 Coronary atherosclerosis of unspecified type of bypass graft 414.06 Coronary atherosclerosis of native coronary artery of transplanted heart 414.07 Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart 414.2 Chronic total occlusion of coronary artery 414.8 Other specified forms of chronic ischemic heart disease 414.9 Chronic ischemic heart disease, unspecified 429.2 Cardiovascular disease, unspecified 188
433.0 Occlusion and stenosis of basilar artery 433.01 Occlusion and stenosis of basilar artery, with cerebral infarction Occlusion and stenosis of carotid artery, without mention of cerebral 433.10 infarction 433.11 Occlusion and stenosis of carotid artery, with cerebral infarction Occlusion and stenosis of vertebral artery, without mention of cerebral 433.20 infarction 433.21 Occlusion and stenosis of vertebral artery, with cerebral infarction Occlusion and stenosis of multiple and bilateral precerebral arteries, without 433.30 mention of cerebral infarction Occlusion and stenosis of multiple and bilateral precerebral arteries, with 433.31 cerebral infarction Occlusion and stenosis of other specified precerebral artery, without mention 433.80 of cerebral infarction Occlusion and stenosis of other specified precerebral artery, with cerebral 433.81 infarction Occlusion and stenosis of unspecified precerebral artery, without mention of 433.90 cerebral infarction Occlusion and stenosis of unspecified precerebral artery, with cerebral 433.91 infarction 434.01 Cerebral thrombosis, with cerebral infarction Occlusion and stenosis of carotid artery, without mention of cerebral 434.10 infarction 434.11 Cerebral embolism, with cerebral infarction 434.90 Cerebral artery occlusion, unspecified, without mention of cerebral infarction 434.91 Cerebral artery occlusion, unspecified, with cerebral infarction 440.1 Atherosclerosis of renal artery 440.20 Atherosclerosis of native arteries of the extremities, unspecified Atherosclerosis of native arteries of the extremities with intermittent 440.21 claudication 440.22 Atherosclerosis of the extremities with rest pain 440.23 Atherosclerosis of native arteries of the extremities with ulceration 440.24 Atherosclerosis of native arteries of the extremities with gangrene 440.29 Other atherosclerosis of native arteries of the extremities 440.4 Chronic total occlusion of artery of the extremities 444.0 Embolism and thrombosis of abdominal aorta 444.1 Embolism and thrombosis of thoracic aorta 444.21 Arterial embolism and thrombosis of upper extremity 444.22 Arterial embolism and thrombosis of lower extremity 444.81 Embolism and thrombosis of iliac artery 444.89 Embolism and thrombosis of other artery 444.9 Embolism and thrombosis of unspecified artery 445.01 Atheroembolism, upper extremity 445.02 Atheroembolism, lower extremity
891136 Aspirin 31200 MG Oral Tablet 892160 Aspirin 3900 MG Oral Tablet 900470 Aspirin 1 MG/MG Oral Powder Encounter acute inpatient - Enter in past medical history Description CPT 99221 99222 99223 99231 99232 99233 99238 99239 99251 99252 99253 99254 99255 99291 1ST HOSP CARE PR D 30 MIN 1ST HOSP CARE PR D 50 MIN 1ST HOSP CARE PR D 70 MIN SBSQ HOSP CARE PR D 15 MIN SBSQ HOSP CARE PR D 25 MIN SBSQ HOSP CARE PR D 35 MIN HOSP DSCHRG D MGMT 30 MIN/< HOSP DSCHRG D MGMT > 30 MIN 1ST INPT CONSLTJ 20 MIN 1ST INPT CONSLTJ 40 MIN 1ST INPT CONSLTJ 55 MIN 1ST INPT CONSLTJ 80 MIN 1ST INPT CONSLTJ 110 MIN CC E/M CRITICALLY ILL/INJURED 1ST 30-74 MIN
192
Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) (NQF 0070) (Additional Measure MENU)
Description: Percentage of patients aged 18 and older with a diagnosis of CAD and prior MI who were prescribed beta-blocker therapy. Diagnosis of coronary artery disease with no MI ICD-9 Description 411 Other acute and subacute forms of ischemic heart disease 411.1 Intermediate coronary syndrome 411.81 Acute coronary occlusion without myocardial infarction 411.89 Other acute and subacute forms of ischemic heart disease 413 Angina pectoris 413.1 Prinzmetal angina 413.9 Other and unspecified angina pectoris 414 Other forms of chronic ischemic heart disease 414.01 Coronary atherosclerosis of native coronary artery 414.02 Coronary atherosclerosis of autologous vein bypass graft 414.03 Coronary atherosclerosis of nonautologous biological bypass graft 414.04 Coronary atherosclerosis of artery bypass graft 414.05 Coronary atherosclerosis of unspecified type of bypass graft 414.06 Coronary atherosclerosis of native coronary artery of transplanted heart 414.07 414.8 414.9 V45.81 V45.82 Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart Other specified forms of chronic ischemic heart disease Chronic ischemic heart disease, unspecified Postsurgical aortocoronary bypass status Percutaneous transluminal coronary angioplasty, postsurgical status
Resolved diagnosis of myocardial infarction ICD-9 Description 410 Acute myocardial infarction 410.01 Acute myocardial infarction, of anterolateral wall, initial episode of care Acute myocardial infarction, of anterolateral wall, subsequent episode 410.02 of care 410.1 Acute myocardial infarction, of other anterior wall 410.11 Acute myocardial infarction, of other anterior wall, initial episode of care 410.12 410.2 410.21 410.22 410.3 410.31 193 Acute myocardial infarction, of other anterior wall, subsequent episode of care Acute myocardial infarction, of inferolateral wall Acute myocardial infarction, of inferolateral wall, initial episode of care Acute myocardial infarction, of inferolateral wall, subsequent episode of care Acute myocardial infarction, of inferoposterior wall Acute myocardial infarction, of inferoposterior wall, initial episode of
care Acute myocardial infarction, of inferoposterior wall, subsequent episode of care Acute myocardial infarction, of other inferior wall Acute myocardial infarction, of other inferior wall, initial episode of care Acute myocardial infarction, of other inferior wall, subsequent episode of care Acute myocardial infarction, of other lateral wall Acute myocardial infarction, of other lateral wall, initial episode of care Acute myocardial infarction, of other lateral wall, subsequent episode of care Acute myocardial infarction, true posterior wall infarction Acute myocardial infarction, true posterior wall infarction, initial episode of care Acute myocardial infarction, true posterior wall infarction, subsequent episode of care Acute myocardial infarction, subendocardial infarction Acute myocardial infarction, subendocardial infarction, initial episode of care Acute myocardial infarction, subendocardial infarction, subsequent episode of care Acute myocardial infarction, of other specified sites Acute myocardial infarction, of other specified sites, initial episode of care Acute myocardial infarction, of other specified sites, subsequent episode of care Acute myocardial infarction, unspecified site Acute myocardial infarction, unspecified site, initial episode of care Acute myocardial infarction, unspecified site, subsequent episode of care Old myocardial infarction
Description Sinoatrial node dysfunction Other specified cardiac dysrhythmias
Description Hypotension Chronic hypotension Hypotension of hemodialysis
Other iatrogenic hypotension Other specified hypotension Hypotension, unspecified
Description Asthma Extrinsic asthma with status asthmaticus Extrinsic asthma, with (acute) exacerbation Intrinsic asthma Intrinsic asthma with status asthmaticus Intrinsic asthma, with (acute) exacerbation Chronic obstructive asthma Chronic obstructive asthma, with status asthmaticus Chronic obstructive asthma, with (acute) exacerbation Exercise induced bronchospasm Cough variant asthma Asthma, unspecified Asthma, unspecified type, with status asthmaticus Asthma, unspecified with (acute) exacerbation
Description Other idiopathic peripheral autonomic neuropathy Sinoatrial node dysfunction Other specified cardiac dysrhythmias
Atresia and stenosis of aorta ICD-9 Description 440 Atherosclerosis 747.22 Congenital atresia and stenosis of aorta Atrioventricular block ICD-9 Description 426 Conduction disorders 426.12 Mobitz (type) II atrioventricular block 426.13 Other second degree atrioventricular block Cardiac pacer nor cardiac pacer in situ ICD-9 Description Cardiac Pacer 14106009 Cardiac pacemaker 360127006 Intravenous cardiac pacemaker system 360128001 Intravenous triggered cardiac pacemaker system 195
424921004 56961003 V45.01
Permanent cardiac pacemaker, device Cardiac transvenous pacemaker Cardiac Pacer in Situ Cardiac pacemaker in situ
At least 1 count of physical exam finding of heart rate less than 50 bpm procedure performed of cardiac monitoring 134377004 Atrial fibrillation monitoring 170576007 Cardiac treatment changed 170599006 24 hr blood pressure monitoring 23852006 Cardiac monitoring 268509003 Cardiac disease monitoring 281568006 Fetal heart monitoring 309877008 Intrapartum cardiotochogram monitoring 38001000 Monitoring of pacemaker 395148004 Cardiac event recording 408804006 Continuous fetal heart monitoring during labor 417206009 Cardiovascular disease monitoring 417287002 Cardiovascular disease interim monitoring 417322008 Cardiovascular disease annual review 422952004 Cardiac telemetry 47101004 Cardiotachometry 50072001 Monitoring of pulse 63818009 Cardiotachometer monitoring 85038003 Tracing of carotid pulse with ECG lead 88140007 Cardiac monitor surveillance
Encounter inpatient - Enter in past medical history CPT Description 99238 99239 HOSP DSCHRG D MGMT 30 MIN/< HOSP DSCHRG D MGMT > 30 MIN
Encounter nursing facility CPT Description 99304 1ST NF CARE PR D E/M LW SEVERITY 99305 1ST NF CARE PR D E/M MOD SEVERITY 99306 1ST NF CARE PR D E/M HI SEVERITY 99307 SBSQ NF CARE PR D E/M STABLE 99308 SBSQ NF CARE PR D E/M MINOR COMPLCTJ 99309 SBSQ NF CARE PR D E/M NEW PROBLEM 99310 SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM
200
Ischemic Vascular Disease (IVD): Blood Pressure Management (NQF 0073) (Additional Measure - MENU)
Description: In the absence of contraindication, beta-blocker therapy has been shown to reduce the risk of a recurrent MI and decrease mortality for those patients with a prior MII (Real-Time Rule). Active Diagnosis – ischemic vascular disease ICD-9CM Description 434.00 Cerebral thrombosis, without mention of cerebral infarction 411.0 Postmyocardial infarction syndrome 411.1 Intermediate coronary syndrome 411.81 Acute coronary occlusion without myocardial infarction 411.89 Other acute and subacute forms of ischemic heart disease 413.0 Angina decubitus 413.1 Prinzmetal angina 413.9 Other and unspecified angina pectoris 414.00 Coronary atherosclerosis of unspecified type of vessel, native or graft 414.01 Coronary atherosclerosis of native coronary artery 414.02 Coronary atherosclerosis of autologous vein bypass graft 414.03 Coronary atherosclerosis of nonautologous biological bypass graft 414.04 Coronary atherosclerosis of artery bypass graft 414.05 Coronary atherosclerosis of unspecified type of bypass graft 414.06 Coronary atherosclerosis of native coronary artery of transplanted heart 414.07 Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart 414.2 Chronic total occlusion of coronary artery 414.8 Other specified forms of chronic ischemic heart disease 414.9 Chronic ischemic heart disease, unspecified 429.2 Cardiovascular disease, unspecified 433.0 Occlusion and stenosis of basilar artery 433.01 Occlusion and stenosis of basilar artery, with cerebral infarction 433.10 Occlusion and stenosis of carotid artery, without mention of cerebral infarction 433.11 Occlusion and stenosis of carotid artery, with cerebral infarction Occlusion and stenosis of vertebral artery, without mention of cerebral 433.20 infarction 433.21 Occlusion and stenosis of vertebral artery, with cerebral infarction Occlusion and stenosis of multiple and bilateral precerebral arteries, without 433.30 mention of cerebral infarction Occlusion and stenosis of multiple and bilateral precerebral arteries, with 433.31 cerebral infarction Occlusion and stenosis of other specified precerebral artery, without mention 433.80 of cerebral infarction Occlusion and stenosis of other specified precerebral artery, with cerebral 433.81 infarction Occlusion and stenosis of unspecified precerebral artery, without mention of 433.90 cerebral infarction Occlusion and stenosis of unspecified precerebral artery, with cerebral 433.91 infarction
Cerebral thrombosis, with cerebral infarction Cerebral embolism, without mention of cerebral infarction Cerebral embolism, with cerebral infarction Cerebral artery occlusion, unspecified, without mention of cerebral infarction Cerebral artery occlusion, unspecified, with cerebral infarction Atherosclerosis of renal artery Atherosclerosis of native arteries of the extremities, unspecified Atherosclerosis of native arteries of the extremities with intermittent claudication Atherosclerosis of the extremities with rest pain Atherosclerosis of native arteries of the extremities with ulceration Atherosclerosis of native arteries of the extremities with gangrene Other atherosclerosis of native arteries of the extremities Chronic total occlusion of artery of the extremities Embolism and thrombosis of abdominal aorta Embolism and thrombosis of thoracic aorta Arterial embolism and thrombosis of upper extremity Arterial embolism and thrombosis of lower extremity Embolism and thrombosis of iliac artery Embolism and thrombosis of other artery Embolism and thrombosis of unspecified artery Atheroembolism, upper extremity Atheroembolism, lower extremity Atheroembolism of other sites Atheroembolism, kidney
Active Diagnosis – acute myocardial infarction ICD-9CM Description 410.01 Acute myocardial infarction, of anterolateral wall, initial episode of care 410.11 Acute myocardial infarction, of other anterior wall, initial episode of care 410.21 Acute myocardial infarction, of inferolateral wall, initial episode of care 410.31 Acute myocardial infarction, of inferoposterior wall, initial episode of care 410.41 Acute myocardial infarction, of other inferior wall, initial episode of care 410.51 Acute myocardial infarction, of other lateral wall, initial episode of care Acute myocardial infarction, true posterior wall infarction, initial episode of 410.61 care 410.71 Acute myocardial infarction, subendocardial infarction, initial episode of care 410.81 Acute myocardial infarction, of other specified sites, initial episode of care 410.91 Acute myocardial infarction, unspecified site, initial episode of care Procedure Performed - CABG CPT Description 33510 CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT 33511 CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS 33512 CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS 33513 CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS 33514 CORONARY ARTERY BYPASS 5 CORONARY VENOUS GRAFTS 202
CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 1 VEIN CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 2 VEIN CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 3 VEIN CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 4 VEIN CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 5 VEIN CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 6 VEIN CAB W/ARTL GRF 1 ARTL GRF CAB W/ARTL GRF 2 C ARTL GRFS CAB W/ARTL GRF 3 C ARTL GRFS CAB W/ARTL GRF 4/> C ARTL GRFS
Procedure Performed - PTCA CPT Description 33140 TRANSMYOCRD LASER REVSC THORCOM SPX 92980 TCAT PLMT AN INTRAC STENT PRQ 1 VSL 92982 PRQ TRLUML C BALO ANGIOP 1 VSL 92995 PRQ TRLUML C ATHRC 1 VSL Encounter – acute inpatient CPT Description 99221 1ST HOSP CARE PR D 30 MIN 99222 1ST HOSP CARE PR D 50 MIN 99223 1ST HOSP CARE PR D 70 MIN 99231 SBSQ HOSP CARE PR D 15 MIN 99232 SBSQ HOSP CARE PR D 25 MIN 99233 SBSQ HOSP CARE PR D 35 MIN 99238 HOSP DSCHRG D MGMT 30 MIN/< 99239 HOSP DSCHRG D MGMT > 30 MIN 99251 1ST INPT CONSLTJ 20 MIN 99252 1ST INPT CONSLTJ 40 MIN 99253 1ST INPT CONSLTJ 55 MIN 99254 1ST INPT CONSLTJ 80 MIN 99255 1ST INPT CONSLTJ 110 MIN 99291 CC E/M CRITICALLY ILL/INJURED 1ST 30-74 MIN
203
Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL Cholesterol (NQF 0074) (Additional Measure - MENU)
Description: Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed a lipid-lowering therapy (based on current ACC/AHA guidelines). Diagnosis of coronary artery disease including MI ICD-9 Description 410 Acute myocardial infarction 410.01 Acute myocardial infarction, of anterolateral wall, initial episode of care 410.02 Acute myocardial infarction, of anterolateral wall, subsequent episode of care 410.1 Acute myocardial infarction, of other anterior wall 410.11 Acute myocardial infarction, of other anterior wall, initial episode of care 410.12 Acute myocardial infarction, of other anterior wall, subsequent episode of care 410.2 Acute myocardial infarction, of inferolateral wall 410.21 Acute myocardial infarction, of inferolateral wall, initial episode of care 410.22 Acute myocardial infarction, of inferolateral wall, subsequent episode of care 410.3 Acute myocardial infarction, of inferoposterior wall 410.31 Acute myocardial infarction, of inferoposterior wall, initial episode of care Acute myocardial infarction, of inferoposterior wall, subsequent episode of 410.32 care 410.4 Acute myocardial infarction, of other inferior wall 410.41 Acute myocardial infarction, of other inferior wall, initial episode of care 410.42 Acute myocardial infarction, of other inferior wall, subsequent episode of care 410.5 Acute myocardial infarction, of other lateral wall 410.51 Acute myocardial infarction, of other lateral wall, initial episode of care 410.52 Acute myocardial infarction, of other lateral wall, subsequent episode of care 410.6 Acute myocardial infarction, true posterior wall infarction 410.61 Acute myocardial infarction, true posterior wall infarction, initial episode of care Acute myocardial infarction, true posterior wall infarction, subsequent episode 410.62 of care 410.7 Acute myocardial infarction, subendocardial infarction 410.71 Acute myocardial infarction, subendocardial infarction, initial episode of care Acute myocardial infarction, subendocardial infarction, subsequent episode of 410.72 care 410.8 Acute myocardial infarction, of other specified sites 410.81 Acute myocardial infarction, of other specified sites, initial episode of care Acute myocardial infarction, of other specified sites, subsequent episode of 410.82 care 410.9 Acute myocardial infarction, unspecified site 410.91 Acute myocardial infarction, unspecified site, initial episode of care 410.92 Acute myocardial infarction, unspecified site, subsequent episode of care 411 Other acute and subacute forms of ischemic heart disease 411.1 Intermediate coronary syndrome 411.81 Acute coronary occlusion without myocardial infarction 411.89 Other acute and subacute forms of ischemic heart disease 412 Old myocardial infarction 413 Angina pectoris 413.1 Prinzmetal angina
Other and unspecified angina pectoris Other forms of chronic ischemic heart disease Coronary atherosclerosis of native coronary artery Coronary atherosclerosis of autologous vein bypass graft Coronary atherosclerosis of nonautologous biological bypass graft Coronary atherosclerosis of artery bypass graft Coronary atherosclerosis of unspecified type of bypass graft Coronary atherosclerosis of native coronary artery of transplanted heart Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart Other specified forms of chronic ischemic heart disease Chronic ischemic heart disease, unspecified Postsurgical aortocoronary bypass status Percutaneous transluminal coronary angioplasty, postsurgical status
Procedure of cardiac surgery - Enter in past surgical history CPT Description 33140 TRANSMYOCRD LASER REVSC THORCOM SPX 33510 CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT 33511 CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS 33512 CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS 33513 CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS 33514 CORONARY ARTERY BYPASS 5 CORONARY VENOUS GRAFTS 33516 CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT 33517 CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 1 VEIN 33518 CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 2 VEIN 33519 CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 3 VEIN 33521 CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 4 VEIN 33522 CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 5 VEIN 33523 CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 6 VEIN 33533 CAB W/ARTL GRF 1 ARTL GRF 33534 CAB W/ARTL GRF 2 C ARTL GRFS 33535 CAB W/ARTL GRF 3 C ARTL GRFS 33536 CAB W/ARTL GRF 4/> C ARTL GRFS 92980 TCAT PLMT AN INTRAC STENT PRQ 1 VSL 92981 TCAT PLMT INTRAC STENT PRQ EA VSL 92982 PRQ TRLUML C BALO ANGIOP 1 VSL 92984 PRQ TRLUML C BALO ANGIOP EA VSL 92995 PRQ TRLUML C ATHRC 1 VSL 92996 PRQ TRLUML C ATHRC EA VSL Last LDL lab test had a value of <130 mg/dL LOINC Description 12773-8 Cholesterol in LDL [Units/volume] in Serum or Plasma by Electrophoresis 13457-7 Cholesterol in LDL [Mass/volume] in Serum or Plasma by calculation 13458-5 Cholesterol in VLDL [Mass/volume] in Serum or Plasma by calculation 14155-6 Cholesterol in LDL [Percentile] 16615-7 Cholesterol.total/Cholesterol in LDL [Mass ratio] in Serum or Plasma 16616-5 Cholesterol in HDL/Cholesterol in LDL [Mass ratio] in Serum or Plasma 18261-8 Cholesterol in LDL [Mass/volume] in Serum or Plasma ultracentrifugate 205
Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay Cholesterol in LDL [Mass/volume] in Serum or Plasma CHOLESTEROL.IN LDL:MCNC:PT:SER/PLAS:QN: Cholesterol in VLDL [Mass/volume] in Serum or Plasma CHOLESTEROL.IN VLDL:MCNC:PT:SER/PLAS:QN: Cholesterol in LDL [Moles/volume] in Serum or Plasma Lipid 1996 panel in Serum or Plasma Cholesterol in VLDL [Moles/volume] in Serum or Plasma Lipids [Mass/volume] in Serum TRIGLYCERIDE+ESTER.IN LDL:MCNC:PT:SER/PLAS:QN: Triglyceride+ester in VLDL [Mass/volume] in Serum or Plasma Cholesterol in LDL [Mass or Moles/volume] in Serum or Plasma Cholesterol in VLDL [Mass or Moles/volume] in Serum or Plasma Lipid screen test status CPHS Cholesterol in LDL [Moles/volume] in Serum or Plasma by calculation
Encounters (Nursing Facility) - Enter in past Medical History CPT Description 99304 1ST NF CARE PR D E/M LW SEVERITY 99305 1ST NF CARE PR D E/M MOD SEVERITY 99306 1ST NF CARE PR D E/M HI SEVERITY 99307 SBSQ NF CARE PR D E/M STABLE 99308 SBSQ NF CARE PR D E/M MINOR COMPLCTJ 99309 SBSQ NF CARE PR D E/M NEW PROBLEM 99310 SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM
208
Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control (NQF 0075) (Additional Measure - MENU)
Description: Individuals with Coronary Artery Disease can reduce their risk of subsequent morbidity and premature morbidity by managing their cholesterol levels. This measure facilitates the management of LDL cholesterol levels of patients with IVD, which can result in a 30% reduction in the incidence of CHD (Real-Time Rule). Active diagnosis - acute myocardial infarction ICD-9CM Description 410.01 Acute myocardial infarction, of anterolateral wall, initial episode of care 410.11 Acute myocardial infarction, of other anterior wall, initial episode of care 410.21 Acute myocardial infarction, of inferolateral wall, initial episode of care 410.31 Acute myocardial infarction, of inferoposterior wall, initial episode of care 410.41 Acute myocardial infarction, of other inferior wall, initial episode of care 410.51 Acute myocardial infarction, of other lateral wall, initial episode of care Acute myocardial infarction, true posterior wall infarction, initial episode of 410.61 care 410.71 Acute myocardial infarction, subendocardial infarction, initial episode of care 410.81 Acute myocardial infarction, of other specified sites, initial episode of care 410.91 Acute myocardial infarction, unspecified site, initial episode of care Active diagnosis – ischemic vascular disease ICD-9CM Description 434.00 Cerebral thrombosis, without mention of cerebral infarction 411.0 Postmyocardial infarction syndrome 411.1 Intermediate coronary syndrome 411.81 Acute coronary occlusion without myocardial infarction 411.89 Other acute and subacute forms of ischemic heart disease 413.0 Angina decubitus 413.1 Prinzmetal angina 413.9 Other and unspecified angina pectoris 414.00 Coronary atherosclerosis of unspecified type of vessel, native or graft 414.01 Coronary atherosclerosis of native coronary artery 414.02 Coronary atherosclerosis of autologous vein bypass graft 414.03 Coronary atherosclerosis of nonautologous biological bypass graft 414.04 Coronary atherosclerosis of artery bypass graft 414.05 Coronary atherosclerosis of unspecified type of bypass graft 414.06 Coronary atherosclerosis of native coronary artery of transplanted heart 414.07 Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart 414.2 Chronic total occlusion of coronary artery 414.8, Other specified forms of chronic ischemic heart disease 414.9 Chronic ischemic heart disease, unspecified 429.2 Cardiovascular disease, unspecified 433.0 Occlusion and stenosis of basilar artery 433.01 Occlusion and stenosis of basilar artery, with cerebral infarction 209
433.10 Occlusion and stenosis of carotid artery, without mention of cerebral infarction 433.11 Occlusion and stenosis of carotid artery, with cerebral infarction Occlusion and stenosis of vertebral artery, without mention of cerebral 433.20 infarction 433.21 Occlusion and stenosis of vertebral artery, with cerebral infarction Occlusion and stenosis of multiple and bilateral precerebral arteries, without 433.30 mention of cerebral infarction Occlusion and stenosis of multiple and bilateral precerebral arteries, with 433.31 cerebral infarction Occlusion and stenosis of other specified precerebral artery, without mention 433.80 of cerebral infarction Occlusion and stenosis of other specified precerebral artery, with cerebral 433.81 infarction Occlusion and stenosis of unspecified precerebral artery, without mention of 433.90 cerebral infarction Occlusion and stenosis of unspecified precerebral artery, with cerebral 433.91 infarction 434.01 Cerebral thrombosis, with cerebral infarction 434.10 Occlusion and stenosis of carotid artery, without mention of cerebral infarction 434.11 Cerebral embolism, with cerebral infarction 434.90 Cerebral artery occlusion, unspecified, without mention of cerebral infarction 434.91 Cerebral artery occlusion, unspecified, with cerebral infarction 440.1 Atherosclerosis of renal artery 440.20 Atherosclerosis of native arteries of the extremities, unspecified Atherosclerosis of native arteries of the extremities with intermittent 440.21 claudication 440.22 Atherosclerosis of the extremities with rest pain 440.23 Atherosclerosis of native arteries of the extremities with ulceration 440.24 Atherosclerosis of native arteries of the extremities with gangrene 440.29 Other atherosclerosis of native arteries of the extremities 440.4 Chronic total occlusion of artery of the extremities 444.0 Embolism and thrombosis of abdominal aorta 444.1 Embolism and thrombosis of thoracic aorta 444.21 Arterial embolism and thrombosis of upper extremity 444.22 Arterial embolism and thrombosis of lower extremity 444.81 Embolism and thrombosis of iliac artery 444.89 Embolism and thrombosis of other artery 444.9 Embolism and thrombosis of unspecified artery 445.01 Atheroembolism, upper extremity 445.02 Atheroembolism, lower extremity Procedure Performed – CABG CPT 33510 33511 33512 33513 210 Description CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS CORONARY ARTERY BYPASS 3 CORONARY VENOUS GRAFTS CORONARY ARTERY BYPASS 4 CORONARY VENOUS GRAFTS
Procedure Performed – PTCA CPT 33140 92980 92982 92995 Description TRANSMYOCRD LASER REVSC THORCOM SPX TCAT PLMT AN INTRAC STENT PRQ 1 VSL PRQ TRLUML C BALO ANGIOP 1 VSL PRQ TRLUML C ATHRC 1 VSL
Laboratory tests performed – High Density Lipoprotein (HDL) LOINC Description 146464 Cholesterol in HDL [Moles/volume] in Serum or Plasma 182634 Cholesterol in HDL [Mass/volume] in Serum or Plasma ultracentrifugate 2085-9 Cholesterol in HDL [Mass/volume] in Serum or Plasma Laboratory tests performed – LDL LOINC Description 127738 Cholesterol in LDL [Units/volume] in Serum or Plasma by Electrophoresis 134577 Cholesterol in LDL [Mass/volume] in Serum or Plasma by calculation 182618 Cholesterol in LDL [Mass/volume] in Serum or Plasma ultracentrifugate 182626 Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay 2089-1 Cholesterol in LDL [Mass/volume] in Serum or Plasma 227488 Cholesterol in LDL [Moles/volume] in Serum or Plasma 394692 Cholesterol in LDL [Moles/volume] in Serum or Plasma by calculation 491324 Cholesterol in LDL [Mass/volume] in Serum or Plasma by Electrophoresis 554402 Cholesterol.in LDL (real) [Mass/volume] in Serum or Plasma by VAP 211
Laboratory tests performed – Total Cholesterol LOINC Description 146472 Cholesterol [Moles/volume] in Serum or Plasma 2093-3 Cholesterol [Mass/volume] in Serum or Plasma Laboratory tests performed – Triglycerides LOINC Description 129510 Triglyceride [Mass/volume] in Serum or Plasma by calculation 149278 Triglyceride [Moles/volume] in Serum or Plasma 2571-8 Triglyceride [Mass/volume] in Serum or Plasma 472100 Triglyceride [Moles/volume] in Serum or Plasma --fasting Encounter – acute inpatient CPT 99221 99222 99223 99231 99232 99233 99238 99239 99251 99252 99253 99254 99255 99291 Description 1ST HOSP CARE PR D 30 MIN 1ST HOSP CARE PR D 50 MIN 1ST HOSP CARE PR D 70 MIN SBSQ HOSP CARE PR D 15 MIN SBSQ HOSP CARE PR D 25 MIN SBSQ HOSP CARE PR D 35 MIN HOSP DSCHRG D MGMT 30 MIN/< HOSP DSCHRG D MGMT > 30 MIN 1ST INPT CONSLTJ 20 MIN 1ST INPT CONSLTJ 40 MIN 1ST INPT CONSLTJ 55 MIN 1ST INPT CONSLTJ 80 MIN 1ST INPT CONSLTJ 110 MIN CC E/M CRITICALLY ILL/INJURED 1ST 30-74 MIN
212
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) (NQF 0081) (Additional Measure - MENU)
Description: Percentage of patients aged 18 years and older with a diagnosis of heart failure and LVSD (LVEF < 40%) who were prescribed ACE inhibitor or ARB therapy. Active diagnosis of heart failure ICD-9 Description 402.01 Hypertensive heart disease, malignant, with heart failure 402.11 Hypertensive heart disease, benign, with heart failure 402.91 Hypertensive heart disease, unspecified, with heart failure 404.01 404.03 404.11 404.13 404.91 404.93 428.1 428.2 428.21 428.22 428.23 428.3 428.31 428.32 428.33 428.4 428.41 428.42 428.43 428.9 213 Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease Left heart failure Systolic heart failure Acute systolic heart failure Chronic systolic heart failure Acute on chronic systolic heart failure Diastolic heart failure Acute diastolic heart failure Chronic diastolic heart failure Acute on chronic diastolic heart failure Combined systolic and diastolic heart failure Acute combined systolic and diastolic heart failure Chronic combined systolic and diastolic heart failure Acute on chronic combined systolic and diastolic heart failure Heart failure, unspecified
Active diagnoses pregnancy ICD-9 V22.0 V22.1 V22.2 V23.0 V23.1 V23.2 V23.3 V23.4 V23.41 V23.49 V23.5 V23.7 V23.8 V23.81 V23.82 V23.83 V23.84 V23.89 V23.9 Description Supervision of normal first pregnancy Supervision of other normal pregnancy Pregnant state, incidental Supervision of high-risk pregnancy with history of infertility Supervision of high-risk pregnancy with history of trophoblastic disease Supervision of high-risk pregnancy with history of abortion Supervision of high-risk pregnancy with grand multiparity Supervision of high-risk pregnancy with other poor obstetric history Pregnancy with history of pre-term labor Pregnancy with other poor obstetric history Supervision of high-risk pregnancy with other poor reproductive history Supervision of high-risk pregnancy: insufficient prenatal care Supervision of other high-risk pregnancy Elderly primigravida Elderly multigravida Young primigravida Young multigravida Other high-risk pregnancy Supervision of unspecified high-risk pregnancy
Active diagnoses deficiencies of circulating enzymes ICD-9 277.6 Description Other deficiencies of circulating enzymes
Active diagnoses disease of aortic and mitral valves ICD-9 395 395.2 396 214 Description Diseases of aortic valve Rheumatic aortic stenosis with insufficiency Diseases of mitral and aortic valves
396.2 396.8
Mitral valve insufficiency and aortic valve stenosis Multiple involvement of mitral and aortic valves
Active diagnoses chronic kidney disease with and without hypertension ICD-9 Description 403.01 403.11 403.91 404.02 404.03 404.12 404.13 404.92 404.93 Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease
Active diagnoses hypertensive renal disease with renal failure ICD-9 Description 403.01 403.11 403.91 404.02 Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end stage renal disease
215
404.03 404.12 404.13 404.92 404.93
Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease
Active diagnoses atherosclerosis of renal artery ICD-9 440.1 Description Atherosclerosis of renal artery
Active diagnoses renal failure and ESRD ICD-9 584.5 584.6 584.7 584.8 584.9 585.5 585.6 586 788.5 Description Acute kidney failure with lesion of tubular necrosis Acute kidney failure with lesion of renal cortical necrosis Acute kidney failure with lesion of renal medullary [papillary] necrosis Acute kidney failure with other specified pathological lesion in kidney Acute kidney failure, unspecified Chronic kidney disease, Stage V End stage renal disease Renal failure, unspecified Oliguria and anuria
Active diagnoses acute renal failure ICD-9 584.5 584.6 584.7 584.8 584.9 Description Acute kidney failure with lesion of tubular necrosis Acute kidney failure with lesion of renal cortical necrosis Acute kidney failure with lesion of renal medullary [papillary] necrosis Acute kidney failure with other specified pathological lesion in kidney Acute kidney failure, unspecified
216
Active diagnoses atresia and stenosis of aorta ICD-9 440.0 747.22 Description Atherosclerosis of aorta Congenital atresia and stenosis of aorta
Diagnostic study result: LVF Assessment result < 40% CPT 78414 78451 78452 78453 78454 78468 78472 78473 78481 78483 78494 78496 93303 93304 93306 93307 93308 93312 93313 93314 93315 93316 93317 93350 93351 217 Description DETER CTR C-V HEMODYN NON-IMG +-RX 1/MLT MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS MYOCARDIAL SPECT MULTIPLE STUDIES MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ CARD BPI GTD =BRM PLNR 1 STD REST/STRS CARD BPI GTD =BRM MLT STD WALL MOTION STD CARD BPI PLNR 1ST PS 1 STD PLUS EJEC FXJ CARD BPI PLNR 1ST PS MLT STD PLUS EJEC FXJ CARD BPI GTD =BRM SPECT REST WALL MOTION CARD BPI GTD =BRM 1 STD REST R VENTR EJEC FXJ TTHRC F/CGEN CAR ANOMAL COMPL TTHRC F/CGEN CAR ANOMAL F-UP/LMTD STD ECHO TTHRC R-T 2D -+M-MODE COMPL SPEC&COLOR DOP TTHRC R-T IMG 2D +-M-MODE REC COMPL TTHRC R-T IMG 2D +-M-MODE REC F-UP/LMTD TEE R-T IMG 2D W/PRB IMG ACQUISJ I&R TEE R-T IMG 2D W/PROBE PLMT ONLY TEE R-T IMG 2D IMG ACQUISJ I&R ONLY TEE CGEN CAR ANOML PRB ACQUISJ I&R TEE CGEN CAR ANOML PLMT PRB ONLY TEE CGEN CAR ANOML IMG ACQUISJ I&R ECHO TTHRC R-T 2D -+M-MODE COMPLETE REST&STRS ECHO TTHRC R-T 2D -+M-MODE REST&STRS CONT ECG
93352 93543
USE OF ECHO CONTRAST AGENT DURING STRESS ECHO INJECTION CARDIAC CATHJ L VENTR/L ATR ANGIOGRAPH
Diagnostic study result: ejection fraction < 40% CPT 250907009 250908004 70822001 Description Left ventricular function Left ventricular ejection fraction Cardiac ejection fraction
Encounters (Nursing Facility) – Enter in Past Medical History CPT 99304 99305 99306 99307 99308 99309 99310 Description 1ST NF CARE PR D E/M LW SEVERITY 1ST NF CARE PR D E/M MOD SEVERITY 1ST NF CARE PR D E/M HI SEVERITY SBSQ NF CARE PR D E/M STABLE SBSQ NF CARE PR D E/M MINOR COMPLCTJ SBSQ NF CARE PR D E/M NEW PROBLEM SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM
Encounter (Inpatient Discharge) – Enter in Past Medical History CPT Description 99238 HOSP DSCHRG D MGMT 30 MIN/< 99239 HOSP DSCHRG D MGMT > 30 MIN
223
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) (NQF 0083) (Additional Measure - MENU)
Description: Percentage of patients aged 18 years and older with a diagnosis of heart failure who also have LVSD (LVEF < 40%) and who were prescribed beta-blocker therapy. Active diagnosis of heart failure ICD9 Description 402.01 Hypertensive heart disease, malignant, with heart failure 402.11 Hypertensive heart disease, benign, with heart failure 402.91 Hypertensive heart disease, unspecified, with heart failure Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or 404.01 unspecified Hypertensive heart and chronic kidney disease, malignant, with heart 404.03 failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, benign, with heart failure 404.11 and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, benign, with heart failure 404.13 and chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or 404.91 unspecified Hypertensive heart and chronic kidney disease, unspecified, with heart 404.93 failure and chronic kidney disease stage V or end stage renal disease 428.1 Left heart failure 428.2 Systolic heart failure 428.21 Acute systolic heart failure 428.22 Chronic systolic heart failure 428.23 Acute on chronic systolic heart failure 428.3 Diastolic heart failure 428.31 Acute diastolic heart failure 428.32 Chronic diastolic heart failure 428.33 Acute on chronic diastolic heart failure 428.4 Combined systolic and diastolic heart failure 428.41 Acute combined systolic and diastolic heart failure 428.42 Chronic combined systolic and diastolic heart failure 428.43 Acute on chronic combined systolic and diastolic heart failure 428.9 Heart failure, unspecified Active diagnosis of arrhythmia ICD9 Description 427.81 Sinoatrial node dysfunction 427.89 Other specified cardiac dysrhythmias
224
Active diagnosis of hypotension ICD9 Description 458 Hypotension 458.1 Chronic hypotension 458.21 Hypotension of hemodialysis 458.29 Other iatrogenic hypotension 458.8 Other specified hypotension 458.9 Hypotension, unspecified Active diagnosis of asthma ICD9 Description 493 Asthma 493.01 Extrinsic asthma with status asthmaticus 493.02 Extrinsic asthma, with (acute) exacerbation 493.1 Intrinsic asthma 493.11 Intrinsic asthma with status asthmaticus 493.12 Intrinsic asthma, with (acute) exacerbation 493.2 Chronic obstructive asthma 493.21 Chronic obstructive asthma, with status asthmaticus 493.22 Chronic obstructive asthma, with (acute) exacerbation 493.81 Exercise induced bronchospasm 493.82 Cough variant asthma 493.9 Asthma, unspecified 493.91 Asthma, unspecified type, with status asthmaticus 493.92 Asthma, unspecified with (acute) exacerbation Active diagnosis of bradycardia ICD9 Description 337.09 Other idiopathic peripheral autonomic neuropathy 427.81 Sinoatrial node dysfunction 427.89 Other specified cardiac dysrhythmias Active Diagnosis of atrioventricular block ICD9 Description 426 Conduction disorders 426.12 Mobitz (type) II atrioventricular block 426.13 Other second degree atrioventricular block Active Diagnosis of cardiac pacer in situ ICD9 Description V45.01 Cardiac pacemaker in situ
225
Active Diagnosis of cardiac pacer device applied ICD9 Description 14106009 Cardiac pacemaker 360127006 Intravenous cardiac pacemaker system 360128001 Intravenous triggered cardiac pacemaker system 424921004 Permanent cardiac pacemaker, device 56961003 Cardiac transvenous pacemaker Diagnostic study result LVF assessment (value) < 40% CPT Descripition 78414 DETER CTR C-V HEMODYN NON-IMG +-RX 1/MLT 78451 MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS 78452 MYOCARDIAL SPECT MULTIPLE STUDIES 78453 MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS 78454 MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES 78468 MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ 78472 CARD BPI GTD =BRM PLNR 1 STD REST/STRS 78473 CARD BPI GTD =BRM MLT STD WALL MOTION STD 78481 CARD BPI PLNR 1ST PS 1 STD PLUS EJEC FXJ 78483 CARD BPI PLNR 1ST PS MLT STD PLUS EJEC FXJ 78494 CARD BPI GTD =BRM SPECT REST WALL MOTION 78496 CARD BPI GTD =BRM 1 STD REST R VENTR EJEC FXJ 93303 TTHRC F/CGEN CAR ANOMAL COMPL 93304 TTHRC F/CGEN CAR ANOMAL F-UP/LMTD STD 93306 ECHO TTHRC R-T 2D -+M-MODE COMPL SPEC&COLOR DOP 93307 TTHRC R-T IMG 2D +-M-MODE REC COMPL 93308 TTHRC R-T IMG 2D +-M-MODE REC F-UP/LMTD 93312 TEE R-T IMG 2D W/PRB IMG ACQUISJ I&R 93313 TEE R-T IMG 2D W/PROBE PLMT ONLY 93314 TEE R-T IMG 2D IMG ACQUISJ I&R ONLY 93315 TEE CGEN CAR ANOML PRB ACQUISJ I&R 93316 TEE CGEN CAR ANOML PLMT PRB ONLY 93317 TEE CGEN CAR ANOML IMG ACQUISJ I&R 93350 ECHO TTHRC R-T 2D -+M-MODE COMPLETE REST&STRS 93351 ECHO TTHRC R-T 2D -+M-MODE REST&STRS CONT ECG 93352 USE OF ECHO CONTRAST AGENT DURING STRESS ECHO 93543 INJECTION CARDIAC CATHJ L VENTR/L ATR ANGIOGRAPH Diagnostic study ejection fraction (value) < 40% CPT Descripition 250907009 Left ventricular function 250908004 Left ventricular ejection fraction 226
Encounters (Nursing Facility) - Enter in past Medical History CPT Description 99304 1ST NF CARE PR D E/M LW SEVERITY 99305 1ST NF CARE PR D E/M MOD SEVERITY 99306 1ST NF CARE PR D E/M HI SEVERITY 99307 SBSQ NF CARE PR D E/M STABLE 99308 SBSQ NF CARE PR D E/M MINOR COMPLCTJ 99309 SBSQ NF CARE PR D E/M NEW PROBLEM 99310 SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM
232
Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation (NQF 0084) (Additional Measure - MENU)
Description: Percentage of all patients aged 18 and older with a diagnosis of heart failure and paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy. Active diagnosis of heart failure ICD-9 Descripition 402.01 Hypertensive heart disease, malignant, with heart failure 402.11 Hypertensive heart disease, benign, with heart failure 402.91 Hypertensive heart disease, unspecified, with heart failure Hypertensive heart and chronic kidney disease, malignant, with heart failure 404.01 and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, malignant, with heart failure 404.03 and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, benign, with heart failure and 404.11 with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, benign, with heart failure and 404.13 chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney disease, unspecified, with heart failure 404.91 and with chronic kidney disease stage I through stage IV, or unspecified 404.93 428.1 428.2 428.21 428.22 428.23 428.3 428.31 428.32 428.33 428.4 428.41 428.42 428.43 428.9 Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease Left heart failure Systolic heart failure Acute systolic heart failure Chronic systolic heart failure Acute on chronic systolic heart failure Diastolic heart failure Acute diastolic heart failure Chronic diastolic heart failure Acute on chronic diastolic heart failure Combined systolic and diastolic heart failure Acute combined systolic and diastolic heart failure Chronic combined systolic and diastolic heart failure Acute on chronic combined systolic and diastolic heart failure Heart failure, unspecified
Active diagnosis of atrial fibrillation ICD-9 Descripition 427.31 Atrial fibrillation Active diagnoses anemias and bleeding disorders ICD-9 Descripition 280 Iron deficiency anemias 280.9 Iron deficiency anemia, unspecified 285.1 Acute posthemorrhagic anemia 233
Coagulation defects Congenital factor IX disorder Congenital factor XI deficiency Congenital deficiency of other clotting factors von Willebrand's disease Hemorrhagic disorder due to intrinsic circulating anticoagulants Defibrination syndrome Acquired coagulation factor deficiency Other and unspecified coagulation defects Primary thrombocytopenia Immune thrombocytopenic purpura Evans' syndrome Congenital and hereditary thrombocytopenic purpura Secondary thrombocytopenia Thrombocytopenia, unspecified Other primary thrombocytopenia
Active diagnoses esophageal and GI bleed ICD-9 530.7 531 531.01 531.2 531.21 531.4 531.41 531.6 531.61 532 532.01 Descripition Gastroesophageal laceration-hemorrhage syndrome Gastric ulcer Acute gastric ulcer with hemorrhage, with obstruction Acute gastric ulcer with hemorrhage and perforation Acute gastric ulcer with hemorrhage and perforation, with obstruction Chronic or unspecified gastric ulcer with hemorrhage Chronic or unspecified gastric ulcer with hemorrhage, with obstruction Chronic or unspecified gastric ulcer with hemorrhage and perforation Chronic or unspecified gastric ulcer with hemorrhage and perforation, with obstruction Duodenal ulcer Acute duodenal ulcer with hemorrhage, with obstruction
Acute duodenal ulcer with hemorrhage and perforation Acute duodenal ulcer with hemorrhage and perforation, with obstruction Chronic or unspecified duodenal ulcer with hemorrhage Chronic or unspecified duodenal ulcer with hemorrhage, with obstruction Chronic or unspecified duodenal ulcer with hemorrhage and perforation Chronic or unspecified duodenal ulcer with hemorrhage and perforation, with obstruction Peptic ulcer, site unspecified Acute peptic ulcer of unspecified site with hemorrhage, with obstruction Acute peptic ulcer of unspecified site with hemorrhage and perforation Acute peptic ulcer of unspecified site with hemorrhage and perforation, with obstruction Chronic or unspecified peptic ulcer of unspecified site with hemorrhage Chronic or unspecified peptic ulcer of unspecified site with hemorrhage, with obstruction Chronic or unspecified peptic ulcer of unspecified site with hemorrhage and perforation Chronic or unspecified peptic ulcer of unspecified site with hemorrhage and perforation, with obstruction Gastrojejunal ulcer Acute gastrojejunal ulcer, with hemorrhage, with obstruction Acute gastrojejunal ulcer with hemorrhage and perforation Acute gastrojejunal ulcer with hemorrhage and perforation, with obstruction Chronic or unspecified gastrojejunal ulcer with hemorrhage
533.41
533.6
533.61 534 534.01 534.2 534.21 534.4
235
534.41 534.6 534.61 569.3 578 578.1 578.9
Chronic or unspecified gastrojejunal ulcer, with hemorrhage, with obstruction Chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation Chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation, with obstruction Hemorrhage of rectum and anus Gastrointestinal hemorrhage Blood in stool Hemorrhage of gastrointestinal tract, unspecified
Active diagnoses intracranial hemorrhage ICD-9 Descripition 430 Subarachnoid hemorrhage 431 Intracerebral hemorrhage 432 Other and unspecified intracranial hemorrhage 432.1 Subdural hemorrhage 432.9 Unspecified intracranial hemorrhage 437.3 Cerebral aneurysm, nonruptured Active diagnoses leukemias/myeloproliferative disorders ICD-9 203 203.01 203.1 203.11 203.8 203.81 204 204.01 204.1 204.11 204.2 236 Descripition Multiple myeloma and immunoproliferative neoplasms Multiple myeloma in remission Plasma cell leukemia Plasma cell leukemia in remission Other immunoproliferative neoplasms Other immunoproliferative neoplasms in remission Lymphoid leukemia Acute lymphoid leukemia in remission Lymphoid leukemia, chronic Chronic lymphoid leukemia in remission Lymphoid leukemia, subacute
Other monocytic leukemia in remission Unspecified monocytic leukemia Unspecified monocytic leukemia in remission Other specified leukemia Acute erythremia and erythroleukemia in remission Chronic erythremia Chronic erythremia in remission Megakaryocytic leukemia Megakaryocytic leukemia in remission Other specified leukemia Other specified leukemia in remission Leukemia of unspecified cell type Acute leukemia of unspecified cell type in remission Leukemia of unspecified cell type, chronic Chronic leukemia of unspecified cell type in remission Leukemia of unspecified cell type, subacute Subacute leukemia of unspecified cell type in remission Other leukemia of unspecified cell type Other leukemia of unspecified cell type in remission Unspecified leukemia Unspecified leukemia in remission
Active diagnoses hematuria ICD-9 Descripition 599.7 Hematuria
Encounters (Nursing Facility) - Enter in past Medical History CPT Descripition 99304 1ST NF CARE PR D E/M LW SEVERITY 99305 1ST NF CARE PR D E/M MOD SEVERITY 99306 1ST NF CARE PR D E/M HI SEVERITY 99307 SBSQ NF CARE PR D E/M STABLE 99308 SBSQ NF CARE PR D E/M MINOR COMPLCTJ 99309 SBSQ NF CARE PR D E/M NEW PROBLEM 99310 SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM
240
Primary Open Angle Glaucoma POAG: Optic Nerve Evaluation (NQF 0086) (Additional Measure - MENU)
Description: Percentage of patients aged 18 years and older with a diagnosis of POAG who have been seen for at least 2 office visits, who have an optic nerve head evaluation during one or more office visits within 12 months. Diagnosis - Primary Open Angle Glaucoma (POAG) ICD9 Description 365.1 Open-angle glaucoma 365.11 Primary open angle glaucoma 365.12 Low tension glaucoma 365.15 Residual stage of open angle glaucoma Enter in Past Medical History or procedures in SOAP note SNOMED Optic Nerve Head Evaluation 171671002 Exploration of optic nerve (II) 36228007 Ophthalmic examination and evaluation Encounter Outpatient Opthamological services - Enter Encounter in Past Medical History CPT Description 92002 OPH MEDICAL XM&EVAL INTRM NEW PT 92004 OPH MEDICAL XM&EVAL COMPRE NEW PT 1+ VST 92012 OPH MEDICAL XM&EVAL INTRM EST PT 92014 OPH MEDICAL XM&EVAL COMPRE EST PT 1+ VST Encounter Nursing Facility CPT Description 99304 1ST NF CARE PR D E/M LW SEVERITY 99304 1ST NF CARE PR D E/M LW SEVERITY 99305 1ST NF CARE PR D E/M MOD SEVERITY 99306 1ST NF CARE PR D E/M HI SEVERITY 99307 SBSQ NF CARE PR D E/M STABLE 99308 SBSQ NF CARE PR D E/M MINOR COMPLCTJ 99309 SBSQ NF CARE PR D E/M NEW PROBLEM 99310 SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM Encounter Domiciliary CPT Description 99324 DOM/R-HOME LW SEVERITY 99325 DOM/R-HOME E/M NEW PT MOD SEVERITY 99326 DOM/R-HOME E/M NEW PT MOD HI SEVERITY 99327 DOM/R-HOME E/M NEW PT HI SEVERITY 99328 DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM 99334 DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 99335 DOM/R-HOME E/M EST PT LW MOD SEVERITY 99336 DOM/R-HOME E/M EST PT MOD HI SEVERITY 99337 DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM 241
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy (NQF 0088) (Additional Measure - MENU)
Description: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months. Active diagnosis of diabetic retinopathy ICD9 362.01 362.02 362.03 362.04 362.05 362.06 Description Background diabetic retinopathy Proliferative diabetic retinopathy Nonproliferative diabetic retinopathy NOS Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic retinopathy Severe nonproliferative diabetic retinopathy
Diabetic macular edema not clinically significant O/E - right eye diabetic maculopathy O/E - left eye diabetic maculopathy O/E - left eye clinically significant macular edema O/E - right eye clinically significant macular edema Exudative maculopathy associated with type I diabetes mellitus Exudative maculopathy associated with type II diabetes mellitus Noncystoid edema of macula of retina
Level of Severity of Retinopathy Findings SNOMED Description 193349004 Preproliferative diabetic retinopathy 312903003 Mild non-proliferative diabetic retinopathy 312904009 Moderate nonproliferative diabetic retinopathy 312905005 Severe nonproliferative diabetic retinopathy 390834004 Nonproliferative diabetic retinopathy 408411003 O/E - right eye preproliferative diabetic retinopathy 408412005 O/E - left eye preproliferative diabetic retinopathy Severity of retinopathy and macular edema findings SNOMED 399872003 399873008 399874002 399875001 399877009 Description Severe nonproliferative diabetic retinopathy with clinically significant macular edema Severe nonproliferative diabetic retinopathy with no macular edema Proliferative diabetic retinopathy - high risk with clinically significant macular edema Non-high-risk proliferative diabetic retinopathy with clinically significant macular edema Very severe nonproliferative diabetic retinopathy with clinically significant macular edema
Ophthalmological Services Procedure CPT Code 92002 92004 92012 92014 Description OPH MEDICAL XM&EVAL INTRM NEW PT OPH MEDICAL XM&EVAL COMPRE NEW PT 1+ VST OPH MEDICAL XM&EVAL INTRM EST PT OPH MEDICAL XM&EVAL COMPRE EST PT 1+ VST
Encounter Nursing Facility Procedure CPT Code 99304 99305 99306 Description 1ST NF CARE PR D E/M LW SEVERITY 1ST NF CARE PR D E/M MOD SEVERITY 1ST NF CARE PR D E/M HI SEVERITY
243
99307 99308 99309 99310
SBSQ NF CARE PR D E/M STABLE SBSQ NF CARE PR D E/M MINOR COMPLCTJ SBSQ NF CARE PR D E/M NEW PROBLEM SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM
Encounter Domiciliary Procedure CPT 99324 99325 99326 99327 99328 99334 99335 99336 99337 Description DOM/R-HOME LW SEVERITY DOM/R-HOME E/M NEW PT MOD SEVERITY DOM/R-HOME E/M NEW PT MOD HI SEVERITY DOM/R-HOME E/M NEW PT HI SEVERITY DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM DOM/R-HOME E/M EST PT SELF-LMTD/MINOR DOM/R-HOME E/M EST PT LW MOD SEVERITY DOM/R-HOME E/M EST PT MOD HI SEVERITY DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM
244
Diabetic Retinopathy: Communication with Physician Managing Ongoing Diabetes Care (NQF 0089) (Additional Measure - MENU)
Description: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the on-going care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months. The applicable diagnosis in their Past Medical or Surgical History or in an encounter note procedure with the "Provider/Facility" or "Surgeon/Facility" field populated. Active diagnosis of diabetic retinopathy ICD9 362.01 362.02 362.03 362.04 362.05 362.06 Description Background diabetic retinopathy Proliferative diabetic retinopathy Nonproliferative diabetic retinopathy NOS Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic retinopathy Severe nonproliferative diabetic retinopathy
Ischaemic diabetic maculopathy Mixed diabetic maculopathy Macular retinal edema Diabetic macular edema not clinically significant O/E - right eye diabetic maculopathy O/E - left eye diabetic maculopathy O/E - left eye clinically significant macular edema O/E - right eye clinically significant macular edema Exudative maculopathy associated with type I diabetes mellitus Exudative maculopathy associated with type II diabetes mellitus Noncystoid edema of macula of retina
Level of Severity of Retinopathy Findings SNOMED Description 193349004 Preproliferative diabetic retinopathy 312903003 Mild non-proliferative diabetic retinopathy 312904009 Moderate nonproliferative diabetic retinopathy 312905005 Severe nonproliferative diabetic retinopathy 390834004 Nonproliferative diabetic retinopathy 408411003 O/E - right eye preproliferative diabetic retinopathy 408412005 O/E - left eye preproliferative diabetic retinopathy Severity of retinopathy and macular edema findings Description Severe nonproliferative diabetic retinopathy with clinically significant 399872003 macular edema 399873008 Severe nonproliferative diabetic retinopathy with no macular edema Proliferative diabetic retinopathy - high risk with clinically significant 399874002 macular edema Non-high-risk proliferative diabetic retinopathy with clinically significant 399875001 macular edema Very severe nonproliferative diabetic retinopathy with clinically significant 399877009 macular edema Communication provider to provider of the macular edema findings Communication provider to provider of the severity of retinopathy findings SNOMED
246
Ophthalmological Services CPT 92002 92004 92012 92014 Description OPH MEDICAL XM&EVAL INTRM NEW PT OPH MEDICAL XM&EVAL COMPRE NEW PT 1+ VST OPH MEDICAL XM&EVAL INTRM EST PT OPH MEDICAL XM&EVAL COMPRE EST PT 1+ VST
Encounter Nursing Facility CPT 99304 99305 99306 99307 99308 99309 99310 Description 1ST NF CARE PR D E/M LW SEVERITY 1ST NF CARE PR D E/M MOD SEVERITY 1ST NF CARE PR D E/M HI SEVERITY SBSQ NF CARE PR D E/M STABLE SBSQ NF CARE PR D E/M MINOR COMPLCTJ SBSQ NF CARE PR D E/M NEW PROBLEM SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM
Encounter Domiciliary CPT 99324 99325 99326 99327 99328 99334 99335 99336 99337 Description DOM/R-HOME LW SEVERITY DOM/R-HOME E/M NEW PT MOD SEVERITY DOM/R-HOME E/M NEW PT MOD HI SEVERITY DOM/R-HOME E/M NEW PT HI SEVERITY DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM DOM/R-HOME E/M EST PT SELF-LMTD/MINOR DOM/R-HOME E/M EST PT LW MOD SEVERITY DOM/R-HOME E/M EST PT MOD HI SEVERITY DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM
247
Anti-depressant Medication Mgmt: (a) Effective Acute Phase Treatment and (b) Effective Continuation Phase Treatment (NQF 0105) (Additional Measure - MENU)
Description: Evaluation of length of treatment serves as an important indicator of success in promoting patient compliance with the establishment and maintenance of an effective medication regimen (Retrospective Rule). Active Diagnosis – depression ICD-9CM Description 296.26 Major depressive disorder, single episode in full remission 296.36 Major depressive disorder, recurrent episode, in full remission 296.4 Bipolar I disorder, most recent episode (or current) manic 296.40 Bipolar I disorder, most recent episode (or current) manic, unspecified 296.41 Bipolar I disorder, most recent episode (or current) manic, mild 296.42 Bipolar I disorder, most recent episode (or current) manic, moderate Bipolar I disorder, most recent episode (or current) manic, severe, without 296.43 mention of psychotic behavior Bipolar I disorder, most recent episode (or current) manic, severe, specified 296.44 as with psychotic behavior Bipolar I disorder, most recent episode (or current) manic, in partial or 296.45 unspecified remission 296.46 Bipolar I disorder, most recent episode (or current) manic, in full remission 296.5 Bipolar I disorder, most recent episode (or current) depressed 296.50 Bipolar I disorder, most recent episode (or current) depressed, unspecified 296.51 Bipolar I disorder, most recent episode (or current) depressed, mild 296.52 Bipolar I disorder, most recent episode (or current) depressed, moderate Bipolar I disorder, most recent episode (or current) depressed, severe, 296.53 without mention of psychotic behavior Bipolar I disorder, most recent episode (or current) depressed, severe, 296.54 specified as with psychotic behavior Bipolar I disorder, most recent episode (or current) depressed, in partial or 296.55 unspecified remission Bipolar I disorder, most recent episode (or current) depressed, in full 296.56 remission 296.60 Bipolar I disorder, most recent episode (or current) mixed, unspecified 296.61 Bipolar I disorder, most recent episode (or current) mixed, mild 296.62 Bipolar I disorder, most recent episode (or current) mixed, moderate Bipolar I disorder, most recent episode (or current) mixed, severe, without 296.63 mention of psychotic behavior Bipolar I disorder, most recent episode (or current) mixed, severe, specified 296.64 as with psychotic behavior Bipolar I disorder, most recent episode (or current) mixed, in partial or 296.65 unspecified remission 296.66 Bipolar I disorder, most recent episode (or current) mixed, in full remission 296.7 Bipolar I disorder, most recent episode (or current) unspecified 248
Other and unspecified bipolar disorders Bipolar disorder, unspecified Atypical manic disorder Atypical depressive disorder Other and unspecified bipolar disorders Other and unspecified episodic mood disorder Unspecified episodic mood disorder Other specified episodic mood disorder Adjustment disorder with depressed mood Adjustment disorder with mixed anxiety and depressed mood
Active Diagnosis – major depression ICD-9CM Description 296.20 Major depression disorder with single episode of depression 296.21 Major depressive disorder, single episode, mild degree 296.22 Major depressive disorder, single episode, moderate degree Major depressive disorder, single episode, severe degree, without mention of 296.23 psychotic behavior Major depressive disorder, single episode, severe degree, specified as with 296.24 psychotic behavior 296.25 Major depressive disorder, single episode, in partial or unspecified remission 296.30 Major depressive disorder, recurrent episode, unspecified degree 296.31 Major depressive disorder, recurrent episode, mild degree 296.32 Major depressive disorder, recurrent episode, moderate degree Major depressive disorder, recurrent episode, severe degree, without mention 296.33 of psychotic behavior Major depressive disorder, recurrent episode, severe degree, specified as 296.34 with psychotic behavior Major depressive disorder, recurrent episode, in partial or unspecified 296.35 remission 298.0 Depressive type psychosis 300.4 Dysthymic disorder 309.1 Adjustment reaction with prolonged depressive reaction 311 Depressive disorder, not elsewhere classified Medication Dispensed – Phenylpiperazine antidepressants RxNorm Description 204453 nefazodone 100 MG Oral Tablet 204454 nefazodone 150 MG Oral Tablet 204455 nefazodone 200 MG Oral Tablet 204456 nefazodone 250 MG Oral Tablet 311923 nefazodone 50 MG Oral Tablet 351128 nefazodone 300 MG Oral Tablet 249
Encounter - ED CPT Description 99281 EMER DEPT SELF LIMITED/MINOR 99282 EMER DEPT LOW TO MODERATE SEVERITY 99283 EMER DEPT MODERATE SEVERITY 99284 EMER DEPT HI SEVERITY&URGENT EVAL 99285 EMER DEPT HIGH SEVERITY&THREAT FUNCJ Encounter – outpatient BH CPT Description 90804 IPI-OB-M/S OFFICE 20-30 MIN 90805 IPI-OB-M/S OFFICE 20-30 MIN MEDICAL E/M 90806 IPI-OB-M/S OFFICE 45-50 MIN 90807 IPI-OB-M/S OFFICE 45-50 MIN MEDICAL E/M 90808 IPI-OB-M/S OFFICE 75-80 MIN 90809 IPI-OB-M/S OFFICE 75-80 MIN MEDICAL E/M 90810 INDIV PSYCTX IA 20-30 MIN 90811 INDIV PSYCTX IA 20-30 MIN MEDICAL E/M 90812 INDIV PSYCTX IA 45-50 MIN 90813 INDIV PSYCTX IA 45-50 MIN MEDICAL E/M 90814 INDIV PSYCTX IA 75-80 MIN 90815 INDIV PSYCTX IA 75-80 MIN MEDICAL E/M 98960 EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT 98961 EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS 98962 EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS 99078 PHYS EDUCATIONAL SVCS RENDERED PTS GRP SETTING 99201 OFFICE OUTPT NEW 10 MIN 99202 OFFICE OUTPT NEW 20 MINUTES 99203 OFFICE OUTPT NEW 30 MIN 99204 OFFICE OUTPT NEW 45 MIN 99205 OFFICE OUTPT NEW 60 MIN 99211 OFFICE O/P EST 5 MIN 99212 OFFICE OUTPT EST 10 MIN 99213 OFFICE OUTPT EST15 MIN 99214 OFFICE OUTPT EST 25 MIN 255
OFFICE OUTPT EST 40 MIN OBS CARE DSCHRG D MGMT 1ST OBS CARE PR D LOW SEVERITY 1ST OBS CARE PR D MODERATE SEVERITY 1ST OBS CARE PR D HIGH SEVERITY OFFICE CONSLTJ 15 MIN OFFICE CONSLTJ 30 MIN OFFICE CONSLTJ 40 MIN OFFICE CONSLTJ 60 MIN OFFICE CONSLTJ 80 MIN HOME VST NEW PT LOW SEVERITY HOME VST NEW PT MOD SEVERITY HOME VST NEW PT MOD TO HI SEVERITY HOME VST NEW PT HI SEVERITY HOME VST NEW PT UNSTABLE/SIGNIFICANT NEW PROBLEM HOME VST EST PT SELF LIMITED/MINOR HOME VST EST PT LOW TO MOD SEVERITY HOME VST EST PT MOD TO HI SEVERITY HOME VST EST PT UNSTABLE/SIGNIFICANT NEW PROBLEM 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 12-17 YR 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 18-39YRS 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 40-64YRS 1ST PREVENTIVE MEDICINE NEW PATIENT AGE 65YRS&> PERIODIC PREVENTIVE MED EST PATIENT AGE 12-17YRS PERIODIC PREVENTIVE MED EST PATIENT AGE 18-39YRS PERIODIC PREVENTIVE MED EST PATIENT AGE 40-64YRS PERIODIC PREVENTIVE MED EST PATIENT AGE 65YRS&> PREV MED CNSL INDIV SPX 15 MIN PREV MED CNSL INDIV SPX 30 MIN PREV MED CNSL INDIV SPX 45 MIN PREV MED CNSL INDIV SPX 60 MIN ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN ALCOHOL/SUBSTANCE SCREEN & INTERVEN >30 MIN PREV MED CNSL GRP SPX 30 MIN PREV MED CNSL GRP SPX 60 MIN HOME VST INDIV FAM/MARRIAGE CNSL
Encounter – non-acute inpatient CPT Description 99304 1ST NF CARE PR D E/M LW SEVERITY 99305 1ST NF CARE PR D E/M MOD SEVERITY
1ST NF CARE PR D E/M HI SEVERITY SBSQ NF CARE PR D E/M STABLE SBSQ NF CARE PR D E/M MINOR COMPLCTJ SBSQ NF CARE PR D E/M NEW PROBLEM SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM NF DSCHRG D MGMT 30 MIN/< NF DSCHRG D MGMT > 30 MIN E/M PT INVG ANNUAL NF ASSMT DOM/R-HOME LW SEVERITY DOM/R-HOME E/M NEW PT MOD SEVERITY DOM/R-HOME E/M NEW PT MOD HI SEVERITY DOM/R-HOME E/M NEW PT HI SEVERITY DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM DOM/R-HOME E/M EST PT SELF-LMTD/MINOR DOM/R-HOME E/M EST PT LW MOD SEVERITY DOM/R-HOME E/M EST PT MOD HI SEVERITY DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM
Encounter – acute inpatient CPT Description 99221 1ST HOSP CARE PR D 30 MIN 99222 1ST HOSP CARE PR D 50 MIN 99223 1ST HOSP CARE PR D 70 MIN 99231 SBSQ HOSP CARE PR D 15 MIN 99232 SBSQ HOSP CARE PR D 25 MIN 99233 SBSQ HOSP CARE PR D 35 MIN 99238 HOSP DSCHRG D MGMT 30 MIN/< 99239 HOSP DSCHRG D MGMT > 30 MIN 99251 1ST INPT CONSLTJ 20 MIN 99252 1ST INPT CONSLTJ 40 MIN 99253 1ST INPT CONSLTJ 55 MIN 99254 1ST INPT CONSLTJ 80 MIN 99255 1ST INPT CONSLTJ 110 MIN 99291 CC E/M CRITICALLY ILL/INJURED 1ST 30-74 MIN
257
Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients (NQF 0385) (Additional Measure - MENU)
Description: Percentage of patients aged 18 years and older with Stage IIIA through IIIC colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period. Active or inactive diagnosis of colon cancer ICD-9 Description 153 Malignant neoplasm of colon 153.1 Malignant neoplasm of transverse colon 153.2 Malignant neoplasm of descending colon 153.3 Malignant neoplasm of sigmoid colon 153.4 Malignant neoplasm of cecum 153.5 Malignant neoplasm of appendix vermiformis 153.6 Malignant neoplasm of ascending colon 153.7 Malignant neoplasm of splenic flexure 153.8 Malignant neoplasm of other specified sites of large intestine 153.9 Malignant neoplasm of colon, unspecified Active diagnosis metastatic sites common to colon cancer 197.7 Malignant neoplasm of liver, specified as secondary Active diagnosis acute renal insufficiency 593.9 Unspecified disorder of kidney and ureter Active diagnosis neutropenia 288 Diseases of white blood cells 288.02 Cyclic neutropenia 288.03 Drug induced neutropenia 288.04 Neutropenia due to infection 288.09 Other neutropenia 89.53 Neutropenic splenomegaly Active diagnosis leucopenia 288.5 Decreased white blood cell count 288.59 Other decreased white blood cell count Procedure result: colon cancer stage III SNOMED 261654001 261656004 261657008 261658003 369921003 258 Description Tumour stage T3a Tumour stage T3bi Tumour stage T3bii Tumour stage T3c T3: Colon/rectum tumour invades through the muscularis propria into the subserosa or the nonperitonealized pericolic or perirectal soft
370046006
tissues T3a,b: Colon/rectum tumour invades <=5 mm beyond the border of the muscularis propria
Poor performance status for ECOG performance - Enter past medical history SNOMED Description 422894000 ECOG performance status - grade 2 423053003 ECOG performance status - grade 3 423237006 ECOG performance status - grade 4 Colon Cancer History V10.05 Personal history of malignant neoplasm of large intestine
259
Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR Positive Breast Cancer) (NQF 0387) (Additional Measure - MENU)
Description: Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period. Active diagnosis of breast cancer – Enter in Diagnosis in the SOAP note Description ICD9 174 Malignant neoplasm of female breast 174.1 Malignant neoplasm of central portion of female breast 174.2 Malignant neoplasm of upper-inner quadrant of female breast 174.3 Malignant neoplasm of lower-inner quadrant of female breast 174.4 Malignant neoplasm of upper-outer quadrant of female breast 174.5 Malignant neoplasm of lower-outer quadrant of female breast 174.6 174.8 174.9 Malignant neoplasm of axillary tail of female breast Malignant neoplasm of other specified sites of female breast Malignant neoplasm of breast (female), unspecified
Inactive diagnosis of breast cancer history ICD9 Description V10.3 Personal history of malignant neoplasm of breast Active diagnosis of metastatic sites common to breast cancer – Enter in SOAP note ICD9 Description 197 Secondary malignant neoplasm of respiratory and digestive systems 197.7 Malignant neoplasm of liver, specified as secondary 198.3 Secondary malignant neoplasm of brain and spinal cord 198.5 Secondary malignant neoplasm of bone and bone marrow Procedure-breast cancer Stage IC-IIIC- enter in past medical history SNO-MED 261650005 261653007 261658003 Description Tumor stage T1c Tumor stage T2c Tumor stage T3c T1c: >1 cm but <= 2 cm in greatest dimension: BREAST: Complete excision less than total mastectomy, total mastectomy, modified radical mastectomy, radical mastectomy T2: Breast tumor > 2 cm but <= 5 cm in greatest dimension T3: Breast tumor >5 cm in greatest dimension
369899008 369900003 369901004
Breast cancer ER or PR positive- past medical history or in procedures SNO-MED Description 416053008 Estrogen receptor positive tumor 416561008 Progesterone receptor positive tumor 417181009 Hormone receptor positive malignant neoplasm of breast 417742002 Hormone receptor positive tumor 260
427685000
HER2-positive carcinoma of breast
Procedure bilateral oophorectomy – Enter in past medical history or procedures CPT 58720 SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX 58940 OOPHORECTOMY PRTL/TOT UNI/BI 58943 OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MAL 58951 RESCJ PRIM PRTL MAL W/BSO&OMNTC TAH&LMPHADEC 58952 RESCJ PRIM PRTL MAL W/BSO&OMNTC RAD DEBULKING 58953 BSO W/OMNTC TAH&RAD DSJ DEBULKING 58954 BSO W/OMNTC TAH DEBULKING W/LMPHADEC 58956 BSO TOT OMNTC TAH MAL Procedure performed radiation therapy CPT Codes Description 77427 RADJ TX MGMT 5 TXS 77435 STEREOTACTIC BODY RADIATION MANAGEMENT 77470 SPEC TX PX Procedure performed chemotherapy- Enter in past medical history or procedures CPT Codes Description 96401 CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO 96402 CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO 96405 CHEMOTX ADMN ILESN UP&W/7 < 96406 CHEMOTX ADMN ILESN > 7 96409 CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG 96411 CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG 96413 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG 96415 CHEMOTHERAPY ADMN IV INFUSION TQ EA HR 96416 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP 96417 CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR 96420 CHEMOTX ADMN IA PUSH TQ 96422 CHEMO IA INFUSION UP TO 1 HR 96423 CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR 96425 CHEMOTX ADMN IA NFS > 8 HR PRTBLE IMPLTBL PMP 96440 CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS 96445 CHEMOTX ADMN PRTL CAVITY REQ&W/PRITONEOCNTS 96450 CHEMOTX ADMN CNS REQ&W/SPI PNXR 96521 RFL/MAIN PORTABLE PMP 96522 RFL/MAIN IMPLTABLE PMP/RSVR F/DRUG DLVR SYSIC 96523 IRRIGATION IMPLTED VAD F/DRUG DLVR SYSS 96542 CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1+ AGENTS 96549 UNLIS CHEMOTX PX Medication ordered or active of tamoxifen or aromatase inhibitor RX Codes Description 198240 Tamoxifen 10 MG Oral Tablet 199224 anastrozole 1 MG Oral Tablet 200064 letrozole 2.5 MG Oral Tablet 261
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients (NQF 0389) (Additional Measure - MENU)
Description: Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer. Active diagnosis of prostate cancer ICD-9 Description 185 Malignant neoplasm of prostate Active diagnosis of pain related to prostate cancer ICD-9 Description 338.3 Neoplasm related pain (acute) (chronic) 724.1 Pain in thoracic spine 724.5 Backache, unspecified 724.6 Disorders of sacrum 724.79 Other disorders of coccyx 733.9 Other and unspecified disorders of bone and cartilage 786.5 Chest pain 786.59 Other chest pain 789 Other symptoms involving abdomen and pelvis V76.44 Screening for malignant neoplasms of prostate V84.03 Genetic susceptibility to malignant neoplasm of prostate Procedure performed of Prostate Cancer Treatment CPT Description 55810 PRST8ECT PRNL RAD 55812 PRST8ECT PRNL RAD LYMPH NODE BX 55815 PRST8ECT PRNL RAD BI PEL LMPHADEC 55840 PRST8ECT RETROPUBIC RAD +-NRV SPARING 55842 PRST8ECT RETROPUBIC RAD LYMPH NODE BX 55845 PRST8ECT RETROPUBIC RAD W/BI PEL LMPHADEC 55866 LAPS PRST8ECT RETROPUBIC RAD W/NRV SPARING 55873 CRYOSURG ABLATION PROSTATE US & MONITORING 77427 RADJ TX MGMT 5 TXS 77776 NTRSTL RADJ SRC APPL SMPL 77777 NTRSTL RADJ SRC APPL INTRM 77778 NTRSTL RADJ SRC APPL CPLX 77787 REMOTE AFTLD RADIONUCLIDE BRACHYTX > 12 CHANNEL
263
Procedure result of AJCC Cancer Stage Low Risk Recurrence Prostate Cancer SNOMED Description 261650005 Tumor stage T1c 261651009 Tumor stage T2a Procedure performed of Salvage Therapy CPT 55860 55862 55865 55875 55876 Description PRST8 SPEC AG CPLXED DIR MEAS EXPOS PRST8 INSJ RADACT NODE BX EXPOS PRST8 INSJ RADACT BI PEL LMPHADEC TPRNL PLMT NDL/CATHS INTO PRST8 RADJ INSJ PLACE INTSTITL DEV RADIATN TX PERQ PROSTATE 1+
Diagnostic study performed of bone scan CPT Description 78300 B1&/JT IMG LMTD AREA 78305 B1&/JT IMG MLT AREAS 78306 B1&/JT IMG WHBDY 78315 B1&/JT IMG 3 PHASE STD 78320 B1&/JT IMG TOMOG SPECT 78350 B1 DNS STD 1+ SITS 1 PHTN ABSRPTM 78351 B1 DNS STD 1+ SITS DUAL PHTN ABSRPTM 1+ SITS Laboratory test result for Prostate Apecific Antigen Test result <= 10 mg/dL CPT Description 84152 PRST8 SPEC AG CPLXED DIR MEAS 84153 PRST8 SPEC AG TOT 84154 PRST8 SPEC AG FR LOINC 10508-0 10886-0 12841-3 14120-0 15323-9 15324-7 15325-4 19195-7 19197-3 19198-1 19199-9 264 Description Prostate specific Ag [Presence] in Tissue by Immune stain Prostate Specific Ag Free [Mass/volume] in Serum or Plasma Prostate Specific Ag Free/Prostate specific Ag.total in Serum or Plasma PROSTATE SPECIFIC AG.FREE/PROSTATE SPECIFIC AG.TOTAL:MFR:PT:SER/PLAS:QN: Prostate specific Ag/Prostate volume calculated from height, width & length Prostate specific Ag/Prostate volume calculated from planimetry Prostate specific Ag/Prostate volume calculated Prostate specific Ag [Units/volume] in Serum or Plasma Prostate specific Ag [Moles/volume] in Serum or Plasma Prostate specific Ag [Units/volume] in Semen Prostate specific Ag [Mass/volume] in Semen
Prostate specific Ag [Moles/volume] in Semen Prostate Specific Ag Free [Units/volume] in Serum or Plasma Prostate Specific Ag Free [Moles/volume] in Serum or Plasma Prostate Specific Ag Free [Units/volume] in Semen Prostate Specific Ag Free [Mass/volume] in Semen Prostate Specific Ag Free [Moles/volume] in Semen Prostate specific Ag [Mass/volume] in Serum or Plasma Prostate specific Ag.protein bound [Mass/volume] in Serum or Plasma Prostate specific Ag [Mass/volume] in Urine Prostate specific Ag [Mass/volume] in Serum or Plasma by Detection limit = 0.01 ng/mL
Lab test result of gleason score <= 6 LOINC Description 35266-6 Gleason score in Specimen Qualitative
265
Diabetes: HbA1c Control (<8%) (NQF 0575) (Additional Measure - MENU)
Description: The percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had HbA1c < 8.0%. Active diagnosis: Diabetes <= 2 years before the end of the measurement period. ICD-9 Description 250 Diabetes Mellitus 250.0 Diabetes Mellitus Without Mention Of Complication 250.00 Diabetes Mellitus Without Mention Of Complication, type two or unspecified type, not stated as uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin, 250.01 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], not stated as uncontrolled, 250.02 Diabetes Mellitus Without Mention Of Complication, Type two or unspecified type, uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.03 Diabetes Mellitus Without Mention Of Complication, Type one [juvenile type], uncontrolled 250.10 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.11 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type] Not Stated As Uncontrolled 250.12 Diabetes Mellitus With Ketoacidosis, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.13 Diabetes Mellitus With Ketoacidosis, Type One [juvenile type], Uncontrolled 250.20 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.21 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Not Stated As Uncontrolled 250.22 Diabetes Mellitus With Hyperosmolar Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.23 Diabetes Mellitus With Hyperosmolar Coma, Type One [juvenile type], Uncontrolled 250.30 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even if the patient requires insulin 250.31 Diabetes Mellitus With Other Coma, Type One [juvenile], Not Stated As Uncontrolled 250.32 Diabetes Mellitus With Other Coma, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin 250.33 Diabetes Mellitus With Other Coma, Type One [juvenile], Uncontrolled 250.4 Diabetes With Renal Manifestations 250.40 Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth digit 0 is for use with type two patients, even
266
250.41 250.42
250.43 250.50
250.51 250.52
250.53 250.60
250.61 250.62
250.63 250.7 250.70
250.71 250.72
250.73 250.8 250.80
if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Renal Manifestations, Type Two or unspecified type, Uncontrolled; Fifth digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Renal Manifestations, Type One [juvenile type]. Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Ophthalmic Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Ophthalmic Manifestations, Type One [juvenile type], Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Not Stated As Uncontrolled Diabetes Mellitus With Neurological Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Neurological Manifestations, Type One [juvenile type] Uncontrolled Diabetes With Peripheral Circulatory Disorders Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Peripheral Circulatory Disorders, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Peripheral Circulatory Disorders, Type One [juvenile type], Uncontrolled Diabetes With Other Specified Manifestations Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Other Specified Manifestations, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin
250.81 250.82
267
250.83 250.9 250.90
Diabetes Mellitus With Other Specified Manifestations, Type One [juvenile type], Uncontrolled Diabetes With Unspecified Complication Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Not Stated As Uncontrolled; Fifth-digit 0 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Not Stated As Uncontrolled Diabetes Mellitus With Unspecified Complication, Type Two or unspecified type, Uncontrolled; Fifth-digit 2 is for use with type two patients, even if the patient requires insulin Diabetes Mellitus With Unspecified Complication, Type One [juvenile type], Uncontrolled Polyneuropathy In Diabetes Diabetic Retinopathy Background Diabetic Retinopathy Proliferative Diabetic Retinopathy Nonproliferative diabetic retinopathy NOS Mild nonproliferative diabetic retinopathy Moderate nonproliferative diabetic retinopathy Severe nonproliferative diabetic retinopathy Diabetic macular edema Diabetic Cataract Diabetes Mellitus Complicating Pregnancy, Childbirth, Or The Puerperium Diabetes Mellitus Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care Diabetes Mellitus Of Mother, With Delivery
The most recent lab test for HbA1c with results of less than 8.0% • Patients will be excluded if: • They have an active diagnosis of polycystic ovaries 256.4 Polycystic Ovaries
268
Active diagnosis of gestational diabetes ICD-9 Description 648.8 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium 648.80 Abnormal Glucose Tolerance Of Mother, Complicating Pregnancy, Childbirth, Or The Puerperium, Unspecified As To Episode Of Care 648.81 Abnormal Glucose Tolerance Of Mother, With Delivery 648.82 Abnormal Glucose Tolerance Of Mother, With Delivery, With Mention Of Postpartum Complication 648.83 Abnormal Glucose Tolerance Of Mother, Antepartum 648.84 Abnormal Glucose Tolerance Of Mother, Postpartum Diagnosis Active of Steroid induced diabetes ICD-9 Description 249 Secondary Diabetes Mellitus 249.0 Secondary diabetes mellitus without mention of complication 249.00 Secondary diabetes mellitus without mention of complication, not stated as uncontrolled or unspecified 249.01 Secondary diabetes mellitus without mention of complication, uncontrolled 249.1 Secondary diabetes mellitus without mention of complication 249.10 Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified 249.11 Secondary diabetes mellitus with ketoacidosis, uncontrolled 249.2 Secondary diabetes mellitus with hyperosmolarity 249.20 Secondary diabetes mellitus with hyperosmolarity, not stated as uncontrolled, or unspecified 249.21 Secondary diabetes mellitus with hyperosmolarity, uncontrolled 249.3 Secondary diabetes mellitus with other coma 249.30 Secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified 249.31 Secondary diabetes mellitus with other coma, uncontrolled 249.4 Secondary diabetes mellitus with renal manifestations 249.40 Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified 249.41 Secondary diabetes mellitus with renal manifestations, uncontrolled 249.5 Secondary diabetes mellitus with ophthalmic manifestations 249.50 Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified 249.51 Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled 249.6, Secondary diabetes mellitus with neurological manifestations 249.60 Secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or unspecified 249.61 Secondary diabetes mellitus with neurological manifestations, uncontrolled 249.7 Secondary diabetes mellitus with peripheral circulatory disorders 249.70 Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or unspecified 249.71 Secondary diabetes mellitus with peripheral circulatory disorders, uncontrolled 249.8 Secondary diabetes mellitus with other specified manifestations 249.80 Secondary diabetes mellitus with other specified manifestations, not stated as 269
249.81 249.9 249.90 249.91 251.8 962.0
uncontrolled, or unspecified Secondary diabetes mellitus with other specified manifestations, uncontrolled Secondary diabetes mellitus with unspecified complication Secondary diabetes mellitus with unspecified complication, not stated as uncontrolled, or unspecified Secondary diabetes mellitus with unspecified complication, uncontrolled Other Specified Disorders Of Pancreatic Internal Secretion Poisoning By Adrenal Cortical Steroids
Encounter Codes Accepted for appointment outside of Physician using MU: CPT Encounte CPT Encounter ED CPT Encounter CPT Encounter r Acute Non-Acute Outpatient Inpatient Inpatient Opthamologi cal services 99221 1ST HOSP CARE PR D 30 MIN 99222 1ST HOSP CARE PR D 50 MIN 99281 EMER DEPT SELF LIMITED/MINO R 99304 1ST NF CARE PR D E/M LW SEVERITY 92002 OPH MEDICAL XM&EVAL INTRM NEW PT OPH MEDICAL XM&EVAL COMPRE NEW PT 1+ VST OPH MEDICAL XM&EVAL INTRM EST PT OPH MEDICAL XM&EVAL COMPRE EST PT 1+ VST
99282
EMER DEPT LOW TO MODERATE SEVERITY
99305
1ST NF CARE PR D E/M MOD SEVERITY
92004
99223 1ST HOSP CARE PR D 70 MIN 99231 SBSQ HOSP CARE PR D 15 MIN
99283
EMER DEPT MODERATE SEVERITY
99306
1ST NF CARE PR D E/M HI SEVERITY
92012
99284
EMER DEPT HI SEVERITY&UR GENT EVAL
99307
SBSQ NF CARE PR D E/M STABLE
92014
99232 SBSQ HOSP CARE PR D 25 MIN 99233 SBSQ HOSP CARE PR D 35 MIN 99238 HOSP DSCHRG 276
99285
EMER DEPT HIGH SEVERITY&TH REAT FUNCJ
99308
SBSQ NF CARE PR D E/M MINOR COMPLCTJ
99309
SBSQ NF CARE PR D E/M NEW PROBLEM
99310
SBSQ NF CARE PR D
D MGMT 30 MIN/<
E/M UNSTABLE/ NEW PROBLEM 99315 NF DSCHRG D MGMT 30 MIN/<
99239 HOSP DSCHRG D MGMT > 30 MIN 99251 1ST 99252 INPT CONSLT J 20 MIN 1ST INPT CONSLT J 40 MIN 99253 1ST INPT CONSLT J 55 MIN 99254 1ST INPT CONSLT J 80 MIN 99255 1ST INPT CONSLT J 110 MIN
99316
NF DSCHRG D MGMT > 30 MIN
99318
E/M PT INVG ANNUAL NF ASSMT DOM/RHOME LW SEVERITY
99324
99325
DOM/RHOME E/M NEW PT MOD SEVERITY DOM/RHOME E/M NEW PT MOD HI SEVERITY DOM/RHOME E/M NEW PT HI SEVERITY DOM/RHOME E/M NEW PT SIGNIFICAN
99326
99327
99328
277
T NEW PROBLEM 99334 DOM/RHOME E/M EST PT SELFLMTD/MINO R DOM/RHOME E/M EST PT LW MOD SEVERITY DOM/RHOME E/M EST PT MOD HI SEVERITY DOM/RHOME E/M EST PT SIGNIFICAN T NEW PROBLEM