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G Codes
G Codes
Procedures / Professional Services (Temporary Codes)
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Codes
g0008
Administration of influenza virus vaccine
g0009
Administration of pneumococcal vaccine
g0010
Administration of hepatitis b vaccine
g0027
Semen analysis; presence and/or motility of sperm excluding huhner
g0028
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
g0029
Tobacco screening not performed or tobacco cessation intervention not provided on the date of the encounter or within the previous 12 months, reason not otherwise specified
g0030
Patient screened for tobacco use and received tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling, pharmacotherapy, or both), if identified as a tobacco user
g0031
Palliative care services given to patient any time during the measurement period
g0032
Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics
g0033
Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines
g0034
Patients receiving palliative care during the measurement period
g0035
Patient has any emergency department encounter during the performance period with place of service indicator 23
g0036
Patient or care partner decline assessment
g0037
On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available
g0038
Clinician determines patient does not require referral
g0039
Patient not referred, reason not otherwise specified
g0040
Patient already receiving physical/occupational/speech/recreational therapy during the measurement period
g0041
Patient and/or care partner decline referral
g0042
Referral to physical, occupational, speech, or recreational therapy
g0043
Patients with mechanical prosthetic heart valve
g0044
Patients with moderate or severe mitral stenosis
g0045
Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention
g0046
Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention
g0047
Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed
g0048
Patients who receive palliative care services any time during the intake period through the end of the measurement year
g0049
With maintenance hemodialysis (in-center and home hd) for the complete reporting month
g0050
Patients with a catheter that have limited life expectancy
g0051
Patients under hospice care in the current reporting month
g0052
Patients on peritoneal dialysis for any portion of the reporting month
g0053
Advancing rheumatology patient care mips value pathways
g0054
Coordinating stroke care to promote prevention and cultivate positive outcomes mips value pathways
g0055
Advancing care for heart disease mips value pathways
g0056
Optimizing chronic disease management mips value pathways
g0057
Proposed adopting best practices and promoting patient safety within emergency medicine mips value pathways
g0058
Improving care for lower extremity joint repair mips value pathways
g0059
Patient safety and support of positive experiences with anesthesia mips value pathways
g0060
Allergy/immunology mips specialty set
g0061
Anesthesiology mips specialty set
g0062
Audiology mips specialty set
g0063
Cardiology mips specialty set
g0064
Certified nurse midwife mips specialty set
g0065
Chiropractic medicine mips specialty set
g0066
Clinical social work mips specialty set
g0067
Dentistry mips specialty set
g0068
Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes
g0069
Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
g0070
Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual's home, each 15 minutes
g0071
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only
g0076
Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0077
Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0078
Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0079
Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0080
Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0081
Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0082
Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0083
Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0084
Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0085
Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0086
Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0087
Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
g0088
Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual's home, each 15 minutes
g0089
Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
g0090
Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes
g0101
Cervical or vaginal cancer screening; pelvic and clinical breast examination
g0102
Prostate cancer screening; digital rectal examination
g0103
Prostate cancer screening; prostate specific antigen test (psa)
g0104
Colorectal cancer screening; flexible sigmoidoscopy
g0105
Colorectal cancer screening; colonoscopy on individual at high risk
g0106
Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
g0108
Diabetes outpatient self-management training services, individual, per 30 minutes
g0109
Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
g0117
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
g0118
Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
g0120
Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
g0121
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
g0122
Colorectal cancer screening; barium enema
g0123
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision
g0124
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
g0127
Trimming of dystrophic nails, any number
g0128
Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes
g0129
Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization treatment program, per session (45 minutes or more)
g0130
Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
g0141
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
g0143
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision
g0144
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision
g0145
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision
g0147
Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
g0148
Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
g0151
Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes
g0152
Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
g0153
Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
g0154
Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes
g0155
Services of clinical social worker in home health or hospice settings, each 15 minutes
g0156
Services of home health/hospice aide in home health or hospice settings, each 15 minutes
g0157
Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes
g0158
Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes
g0159
Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes
g0160
Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
g0161
Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes
g0162
Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)
g0163
Skilled services of a licensed nurse (lpn or rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)
g0164
Skilled services of a licensed nurse (lpn or rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
g0166
External counterpulsation, per treatment session
g0168
Wound closure utilizing tissue adhesive(s) only
g0173
Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session
g0175
Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present
g0176
Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more)
g0177
Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more)
g0179
Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care
g0180
Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care
g0181
Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allowed practitioner development and/or revision of care plans
g0182
Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more
g0186
Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions)
g0202
Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
g0204
Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral
g0206
Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral
g0219
Pet imaging whole body; melanoma for non-covered indications
g0235
Pet imaging, any site, not otherwise specified
g0237
Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)
g0238
Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)
g0239
Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)
g0245
Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education
g0246
Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education
g0247
Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
g0248
Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results
g0249
Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
g0250
Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests
g0251
Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment
g0252
Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes)
g0255
Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve
g0257
Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility
g0259
Injection procedure for sacroiliac joint; arthrography
g0260
Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography
g0268
Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing
g0269
Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)
g0270
Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes
g0271
Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes
g0276
Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial
g0277
Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval
g0278
Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)
g0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
g0281
Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care
g0282
Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281
g0283
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care
g0288
Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery
g0289
Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee
g0293
Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day
g0294
Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day
g0295
Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses
g0296
Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making)
g0297
Low dose ct scan (ldct) for lung cancer screening
g0299
Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes
g0300
Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes
g0302
Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services
g0303
Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services
g0304
Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services
g0305
Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services
g0306
Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count
g0307
Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)
g0327
Colorectal cancer screening; blood-based biomarker
g0328
Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous
g0329
Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care
g0333
Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary
g0337
Hospice evaluation and counseling services, pre-election
g0339
Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment
g0340
Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment
g0341
Percutaneous islet cell transplant, includes portal vein catheterization and infusion
g0342
Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion
g0343
Laparotomy for islet cell transplant, includes portal vein catheterization and infusion
g0364
Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service
g0365
Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow)
g0372
Physician service required to establish and document the need for a power mobility device
g0378
Hospital observation service, per hour
g0379
Direct admission of patient for hospital observation care
g0380
Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
g0381
Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
g0382
Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
g0383
Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
g0384
Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
g0389
Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening
g0390
Trauma response team associated with hospital critical care service
g0396
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
g0397
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
g0398
Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation
g0399
Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation
g0400
Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels
g0402
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
g0403
Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
g0404
Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
g0405
Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
g0406
Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
g0407
Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
g0408
Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
g0409
Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf)
g0410
Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes
g0411
Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes
g0412
Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed
g0413
Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)
g0414
Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami)
g0415
Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)
g0416
Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method
g0417
Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens
g0418
Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens
g0419
Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens
g0420
Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour
g0421
Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour
g0422
Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session
g0423
Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session
g0424
Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day
g0425
Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth
g0426
Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
g0427
Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth
g0428
Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)
g0429
Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)
g0431
Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
g0432
Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening
g0433
Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening
g0434
Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter
g0435
Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening
g0436
Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
g0437
Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
g0438
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
g0439
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
g0442
Annual alcohol misuse screening, 15 minutes
g0443
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
g0444
Annual depression screening, 15 minutes
g0445
High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
g0446
Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
g0447
Face-to-face behavioral counseling for obesity, 15 minutes
g0448
Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing
g0451
Development testing, with interpretation and report, per standardized instrument form
g0452
Molecular pathology procedure; physician interpretation and report
g0453
Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)
g0454
Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist
g0455
Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen
g0456
Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters
g0457
Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters
g0458
Low dose rate (ldr) prostate brachytherapy services, composite rate
g0459
Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy
g0460
Autologous platelet rich plasma for non-diabetic chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment
g0461
Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain
g0462
Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure)
g0463
Hospital outpatient clinic visit for assessment and management of a patient
g0464
Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3)
g0465
Autologous platelet rich plasma (prp) for diabetic chronic wounds/ulcers, using an fda-cleared device (includes administration, dressings, phlebotomy, centrifugation, and all other preparatory procedures, per treatment)
g0466
Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit
g0467
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit
g0468
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv
g0469
Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit
g0470
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit
g0471
Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha)
g0472
Hepatitis c antibody screening, for individual at high risk and other covered indication(s)
g0473
Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes
g0475
Hiv antigen/antibody, combination assay, screening
g0476
Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test
g0477
Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service
g0478
Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service
g0479
Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, tof, maldi, ldtd, desi, dart, ghpc, gc mass spectrometry), includes sample validation when performed, per date of service
g0480
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed
g0481
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed
g0482
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed
g0483
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed
g0490
Face-to-face home health nursing visit by a rural health clinic (rhc) or federally qualified health center (fqhc) in an area with a shortage of home health agencies; (services limited to rn or lpn only)
g0491
Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd
g0492
Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd
g0493
Skilled services of a registered nurse (rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)
g0494
Skilled services of a licensed practical nurse (lpn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)
g0495
Skilled services of a registered nurse (rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
g0496
Skilled services of a licensed practical nurse (lpn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes
g0498
Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion
g0499
Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to hepatitis b core antigen (anti-hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag result
g0500
Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)
g0501
Resource-intensive services for patients for whom the use of specialized mobility-assistive technology (such as adjustable height chairs or tables, patient lift, and adjustable padded leg supports) is medically necessary and used during the provision of an office/outpatient, evaluation and management visit (list separately in addition to primary service)
g0502
Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
g0503
Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment
g0504
Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (list separately in addition to code for primary procedure); (use g0504 in conjunction with g0502, g0503)
g0505
Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, in office or other outpatient setting or home or domiciliary or rest home
g0506
Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)
g0507
Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team
g0508
Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth
g0509
Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth
g0511
Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month
g0512
Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month
g0513
Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)
g0514
Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service)
g0515
Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
g0516
Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)
g0517
Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
g0518
Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
g0659
Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes
g0908
Most recent hemoglobin (hgb) level > 12.0 g/dl
g0909
Hemoglobin level measurement not documented, reason not given
g0910
Most recent hemoglobin level <= 12.0 g/dl
g0913
Improvement in visual function achieved within 90 days following cataract surgery
g0914
Patient care survey was not completed by patient
g0915
Improvement in visual function not achieved within 90 days following cataract surgery
g0916
Satisfaction with care achieved within 90 days following cataract surgery
g0917
Patient satisfaction survey was not completed by patient
g0918
Satisfaction with care not achieved within 90 days following cataract surgery
g0919
Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit
g0920
Type, anatomic location, and activity all documented
g0921
Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment)
g0922
No documentation of disease type, anatomic location, and activity, reason not given
g1000
Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program
g1001
Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program
g1002
Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program
g1003
Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program
g1004
Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program
g1005
Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program
g1006
Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program
g1007
Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program
g1008
Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program
g1009
Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program
g1010
Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program
g1011
Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program
g1012
Clinical decision support mechanism agilemd, as defined by the medicare appropriate use criteria program
g1013
Clinical decision support mechanism evidencecare imagingcare, as defined by the medicare appropriate use criteria program
g1014
Clinical decision support mechanism inveniqa semantic answers in medicine, as defined by the medicare appropriate use criteria program
g1015
Clinical decision support mechanism reliant medical group, as defined by the medicare appropriate use criteria program
g1016
Clinical decision support mechanism speed of care, as defined by the medicare appropriate use criteria program
g1017
Clinical decision support mechanism healthhelp, as defined by the medicare appropriate use criteria program
g1018
Clinical decision support mechanism infinx, as defined by the medicare appropriate use criteria program
g1019
Clinical decision support mechanism logicnets, as defined by the medicare appropriate use criteria program
g1020
Clinical decision support mechanism curbside clinical augmented workflow, as defined by the medicare appropriate use criteria program
g1021
Clinical decision support mechanism ehealthline clinical decision support mechanism, as defined by the medicare appropriate use criteria program
g1022
Clinical decision support mechanism intermountain clinical decision support mechanism, as defined by the medicare appropriate use criteria program
g1023
Clinical decision support mechanism persivia clinical decision support, as defined by the medicare appropriate use criteria program
g1024
Clinical decision support mechanism radrite, as defined by the medicare appropriate use criteria program
g1025
Patient-months where there are more than one medicare capitated payment (mcp) provider listed for the month
g1026
The number of adult patient-months in the denominator who were on maintenance hemodialysis using a catheter continuously for three months or longer under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month
g1027
The number of adult patient-months in the denominator who were on maintenance hemodialysis under the care of the same practitioner or group partner as of the last hemodialysis session of the reporting month using a catheter continuously for less than three months
g1028
Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
g2000
Blinded administration of convulsive therapy procedure, either electroconvulsive therapy (ect, current covered gold standard) or magnetic seizure therapy (mst, non-covered experimental therapy), performed in an approved ide-based clinical trial, per treatment session
g2001
Brief (20 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2002
Limited (30 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2003
Moderate (45 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2004
Comprehensive (60 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2005
Extensive (75 minutes) in-home visit for a new patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2006
Brief (20 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2007
Limited (30 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2008
Moderate (45 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2009
Comprehensive (60 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2010
Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment
g2011
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes
g2012
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
g2013
Extensive (75 minutes) in-home visit for an existing patient post-discharge. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2014
Limited (30 minutes) care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility and no more than 9 times.)
g2015
Comprehensive (60 mins) home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility within 90 days following discharge from an inpatient facility.)
g2020
Services for high intensity clinical services associated with the initial engagement and outreach of beneficiaries assigned to the sip component of the pcf model (do not bill with chronic care management codes)
g2021
Health care practitioners rendering treatment in place (tip)
g2022
A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place)
g2023
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source
g2024
Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a snf or by a laboratory on behalf of a hha, any specimen source
g2025
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only
g2058
Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure). (do not report g2058 for care management services of less than 20 minutes additional to the first 20 minutes of chronic care management services during a calendar month). (use g2058 in conjunction with 99490). (do not report 99490, g2058 in the same calendar month as 99487, 99489, 99491)).
g2061
Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes
g2062
Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes
g2063
Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes
g2064
Comprehensive care management services for a single high-risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
g2065
Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
g2066
Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
g2067
Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program)
g2068
Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
g2069
Medication assisted treatment, buprenorphine (injectable); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
g2070
Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
g2071
Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
g2072
Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
g2073
Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
g2074
Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
g2075
Medication assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program)
g2076
Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician qualified personnel that includes preparation of a treatment plan that includes the patient's short-term goals and the tasks the patient must perform to complete the short-term goals; the patient's requirements for education, vocational rehabilitation, and employment; and the medical, psycho- social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
g2077
Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
g2078
Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
g2079
Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
g2080
Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
g2081
Patients age 66 and older in institutional special needs plans (snp) or residing in long-term care with a pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
g2082
Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation
g2083
Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observation
g2086
Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month
g2087
Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month
g2088
Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure)
g2089
Most recent hemoglobin a1c (hba1c) level 7.0 to 9.0%
g2090
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2091
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2092
Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy prescribed or currently being taken
g2093
Documentation of medical reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons)
g2094
Documentation of patient reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., patient declined, other patient reasons)
g2095
Documentation of system reason(s) for not prescribing ace inhibitor or arb or arni therapy (e.g., other system reasons)
g2096
Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) or angiotensin receptor-neprilysin inhibitor (arni) therapy was not prescribed, reason not given
g2097
Episodes where the patient had a competing diagnosis on or within three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, chronic sinusitis, infection of the adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti)
g2098
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2099
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2100
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2101
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2102
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed
g2103
Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed
g2104
Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed
g2105
Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
g2106
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2107
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2108
Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
g2109
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2110
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2112
Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months
g2113
Patient receiving >5 mg daily prednisone (or equivalent) for longer than 6 months, and improvement or no change in disease activity
g2114
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2115
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2116
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2117
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2118
Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period
g2119
Within the past 2 years, calcium and/or vitamin d optimization has been ordered or performed
g2120
Within the past 2 years, calcium and/or vitamin d optimization has not been ordered or performed
g2121
Depression, anxiety, apathy, and psychosis assessed
g2122
Depression, anxiety, apathy, and psychosis not assessed
g2123
Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2124
Patients 66-80 years of age and had at least one claim/encounter for frailty during the measurement period and a dispensed dementia medication
g2125
Patients 81 years of age and older with at least one claim/encounter for frailty during the six months prior to the measurement period through december 31 of the measurement period
g2126
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2127
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2128
Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g. history of gastrointestinal bleed, intra-cranial bleed, blood disorders, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)
g2129
Procedure-related bp's not taken during an outpatient visit. examples include same day surgery, ambulatory service center, g.i. lab, dialysis, infusion center, chemotherapy
g2130
Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 days during the measurement period
g2131
Patients 81 years and older with a diagnosis of frailty
g2132
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2133
Patients 66-80 years of age with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2134
Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
g2135
Patients 66 years of age or older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
g2136
Back pain measured by the visual analog scale (vas) at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater
g2137
Back pain measured by the visual analog scale (vas) at three months (6 - 20 weeks) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated a change of less than an improvement of 5.0 points
g2138
Back pain as measured by the visual analog scale (vas) at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or back pain measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated a change of 5.0 points or greater
g2139
Back pain measured by the visual analog scale (vas) pain at one year (9 to 15 months) postoperatively was greater than 3.0 and back pain measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated a change of less than 5.0
g2140
Leg pain measured by the visual analog scale (vas) at three months (6 - 20 weeks) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater
g2141
Leg pain measured by the visual analog scale (vas) at three months (6 - 20 weeks) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated less than an improvement of 5.0 points
g2142
Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater
g2143
Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of less than 30 points
g2144
Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 ? 20 weeks) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of 30 points or greater
g2145
Functional status measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively was greater than 22 and functional status measured by the odi version 2.1a within three months preoperatively and at three months (6 - 20 weeks) postoperatively demonstrated an improvement of less than 30 points
g2146
Leg pain as measured by the visual analog scale (vas) at one year (9 to 15 months) postoperatively was less than or equal to 3.0 or leg pain measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 5.0 points or greater
g2147
Leg pain measured by the visual analog scale (vas) at one year (9 to 15 months) postoperatively was greater than 3.0 and leg pain measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated less than an improvement of 5.0 points
g2148
Multimodal pain management was used
g2149
Documentation of medical reason(s) for not using multimodal pain management (e.g., allergy to multiple classes of analgesics, intubated patient, hepatic failure, patient reports no pain during pacu stay, other medical reason(s))
g2150
Multimodal pain management was not used
g2151
Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care
g2152
Risk-adjusted functional status change residual score for the neck impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
g2153
In hospice or using hospice services during the measurement period
g2154
Patient received at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period
g2155
Patient had history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.)
g2156
Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the start of the measurement period and the end of the measurement period; or have history of at least one of the following contraindications any time during or before the measurement period: anaphylaxis due to tdap vaccine, anaphylaxis due to td vaccine or its components; encephalopathy due to tdap or td vaccination (post tetanus vaccination encephalitis, post diphtheria vaccination encephalitis or post pertussis vaccination encephalitis.)
g2157
Patients received both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during the measurement period
g2158
Patient had prior pneumococcal vaccine adverse reaction any time during or before the measurement period
g2159
Patient did not receive both the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine at least 12 months apart, with the first occurrence after the age of 60 before or during measurement period; or have prior pneumococcal vaccine adverse reaction any time during or before the measurement period
g2160
Patient received at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period
g2161
Patient had prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period
g2162
Patient did not receive at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient's 50th birthday before or during the measurement period; or have prior adverse reaction caused by zoster vaccine or its components any time during or before the measurement period
g2163
Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period
g2164
Patient had a prior influenza virus vaccine adverse reaction any time before or during the measurement period
g2165
Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period; or did not have a prior influenza virus vaccine adverse reaction any time before or during the measurement period
g2166
Patient refused to participate at admission and/or discharge; patient unable to complete the neck fs prom at admission or discharge due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, and a suitable proxy/recorder is not available; patient self-discharged early; medical reason
g2167
Risk-adjusted functional status change residual score for the neck impairment successfully calculated and the score was less than zero (< 0)
g2168
Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes
g2169
Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
g2170
Percutaneous arteriovenous fistula creation (avf), direct, any site, by tissue approximation using thermal resistance energy, and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization) when performed, and includes all imaging and radiologic guidance, supervision and interpretation, when performed
g2171
Percutaneous arteriovenous fistula creation (avf), direct, any site, using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, wen performed) and fistulogram(s), angiography, enography, and/or ultrasound, with radiologic supervision and interpretation, when performed
g2172
All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project
g2173
Uri episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
g2174
Uri episodes when the patient had an active prescription of antibiotics (table 1) in the 30 days prior to the episode date
g2175
Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date (e.g., tuberculosis, neutropenia, cystic fibrosis, chronic bronchitis, pulmonary edema, respiratory failure, rheumatoid lung disease)
g2176
Outpatient, ed, or observation visits that result in an inpatient admission
g2177
Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (table 1) in the 30 days prior to the episode date
g2178
Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure, for example patient bilateral amputee; patient has condition that would not allow them to accurately respond to a neurological exam (dementia, alzheimer's, etc.); patient has previously documented diabetic peripheral neuropathy with loss of protective sensation
g2179
Clinician documented that patient had medical reason for not performing lower extremity neurological exam
g2180
Clinician documented that patient was not an eligible candidate for evaluation of footwear as patient is bilateral lower extremity amputee
g2181
Bmi not documented due to medical reason or patient refusal of height or weight measurement
g2182
Patient receiving first-time biologic disease modifying anti-rheumatic drug therapy
g2183
Documentation patient unable to communicate and informant not available
g2184
Patient does not have a caregiver
g2185
Documentation caregiver is trained and certified in dementia care
g2186
Patient /caregiver dyad has been referred to appropriate resources and connection to those resources is confirmed
g2187
Patients with clinical indications for imaging of the head: head trauma
g2188
Patients with clinical indications for imaging of the head: new or change in headache above 50 years of age
g2189
Patients with clinical indications for imaging of the head: abnormal neurologic exam
g2190
Patients with clinical indications for imaging of the head: headache radiating to the neck
g2191
Patients with clinical indications for imaging of the head: positional headaches
g2192
Patients with clinical indications for imaging of the head: temporal headaches in patients over 55 years of age
g2193
Patients with clinical indications for imaging of the head: new onset headache in pre-school children or younger (<6 years of age)
g2194
Patients with clinical indications for imaging of the head: new onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior
g2195
Patients with clinical indications for imaging of the head: occipital headache in children
g2196
Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
g2197
Patient screened for unhealthy alcohol use using a systematic screening method and not identified as an unhealthy alcohol user
g2198
Documentation of medical reason(s) for not screening for unhealthy alcohol use using a systematic screening method (e.g., limited life expectancy, other medical reasons)
g2199
Patient not screened for unhealthy alcohol use using a systematic screening method, reason not given
g2200
Patient identified as an unhealthy alcohol user received brief counseling
g2201
Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
g2202
Patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given
g2203
Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons)
g2204
Patients between 50 and 85 years of age who received a screening colonoscopy during the performance period
g2205
Patients with pregnancy during adjuvant treatment course
g2206
Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy
g2207
Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky =50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
g2208
Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy
g2209
Patient refused to participate
g2210
Risk-adjusted functional status change residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given
g2211
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)
g2212
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)
g2213
Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure)
g2214
Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional
g2215
Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
g2216
Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
g2250
Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
g2251
Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
g2252
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
g3001
Administration and supply of tositumomab, 450 mg
g4000
Dermatology mips specialty set
g4001
Diagnostic radiology mips specialty set
g4002
Electrophysiology cardiac specialist mips specialty set
g4003
Emergency medicine mips specialty set
g4004
Endocrinology mips specialty set
g4005
Family medicine mips specialty set
g4006
Gastro-enterology mips specialty set
g4007
General surgery mips specialty set
g4008
Geriatrics mips specialty set
g4009
Hospitalists mips specialty set
g4010
Infectious disease mips specialty set
g4011
Internal medicine mips specialty set
g4012
Interventional radiology mips specialty set
g4013
Mental/behavioral health mips specialty set
g4014
Nephrology mips specialty set
g4015
Neurology mips specialty set
g4016
Neurosurgical mips specialty set
g4017
Nutrition/dietician mips specialty set
g4018
Obstetrics/gynecology mips specialty set
g4019
Oncology/hematology mips specialty set
g4020
Ophthalmology mips specialty set
g4021
Orthopedic surgery mips specialty set
g4022
Otolaryngology mips specialty set
g4023
Pathology mips specialty set
g4024
Pediatrics mips specialty set
g4025
Physical medicine mips specialty set
g4026
Physical therapy/occupational therapy mips specialty set
g4027
Plastic surgery mips specialty set
g4028
Podiatry mips specialty set
g4029
Preventive medicine mips specialty set
g4030
Pulmonology mips specialty set
g4031
Radiation oncology mips specialty set
g4032
Rheumatology mips specialty set
g4033
Skilled nursing facility mips specialty set
g4034
Speech language pathology mips specialty set
g4035
Thoracic surgery mips specialty set
g4036
Urgent care mips specialty set
g4037
Urology mips specialty set
g4038
Vascular surgery mips specialty set
g6001
Ultrasonic guidance for placement of radiation therapy fields
g6002
Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy
g6003
Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev
g6004
Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev
g6005
Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev
g6006
Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater
g6007
Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev
g6008
Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev
g6009
Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev
g6010
Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater
g6011
Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev
g6012
Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev
g6013
Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev
g6014
Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater
g6015
Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session
g6016
Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session
g6017
Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg,3d positional tracking, gating, 3d surface tracking), each fraction of treatment
g6018
Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation)
g6019
Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
g6020
Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)
g6021
Unlisted procedure, intestine
g6022
Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
g6023
Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)
g6024
Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
g6025
Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)
g6027
Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed
g6028
Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); with biopsy(ies)
g6030
Amitriptyline
g6031
Benzodiazepines
g6032
Desipramine
g6034
Doxepin
g6035
Gold
g6036
Assay of imipramine
g6037
Nortriptyline
g6038
Salicylate
g6039
Acetaminophen
g6040
Alcohol (ethanol); any specimen except breath
g6041
Alkaloids, urine, quantitative
g6042
Amphetamine or methamphetamine
g6043
Barbiturates, not elsewhere specified
g6044
Cocaine or metabolite
g6045
Dihydrocodeinone
g6046
Dihydromorphinone
g6047
Dihydrotestosterone
g6048
Dimethadione
g6049
Epiandrosterone
g6050
Ethchlorvynol
g6051
Flurazepam
g6052
Meprobamate
g6053
Methadone
g6054
Methsuximide
g6055
Nicotine
g6056
Opiate(s), drug and metabolites, each procedure
g6057
Phenothiazine
g6058
Drug confirmation, each procedure
g8126
Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase
g8127
Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase
g8128
Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure
g8395
Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function
g8396
Left ventricular ejection fraction (lvef) not performed or documented
g8397
Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy
g8398
Dilated macular or fundus exam not performed
g8399
Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed
g8400
Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given
g8401
Clinician documented that patient was not an eligible candidate for screening
g8404
Lower extremity neurological exam performed and documented
g8405
Lower extremity neurological exam not performed
g8406
Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure
g8410
Footwear evaluation performed and documented
g8415
Footwear evaluation was not performed
g8416
Clinician documented that patient was not an eligible candidate for footwear evaluation measure
g8417
Bmi is documented above normal parameters and a follow-up plan is documented
g8418
Bmi is documented below normal parameters and a follow-up plan is documented
g8419
Bmi documented outside normal parameters, no follow-up plan documented, no reason given
g8420
Bmi is documented within normal parameters and no follow-up plan is required
g8421
Bmi not documented and no reason is given
g8422
Bmi not documented, documentation the patient is not eligible for bmi calculation
g8427
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications
g8428
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given
g8430
Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an urgent or emergent medical situation)
g8431
Screening for depression is documented as being positive and a follow-up plan is documented
g8432
Depression screening not documented, reason not given
g8433
Screening for depression not completed, documented patient or medical reason
g8442
Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter
g8450
Beta-blocker therapy prescribed
g8451
Beta-blocker therapy for lvef < 40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons, or other reasons attributable to the healthcare system)
g8452
Beta-blocker therapy not prescribed
g8458
Clinician documented that patient is not an eligible candidate for genotype testing; patient not receiving antiviral treatment for hepatitis c during the measurement period (e.g. genotype test done prior to the reporting period, patient declines, patient not a candidate for antiviral treatment)
g8460
Clinician documented that patient is not an eligible candidate for quantitative rna testing at week 12; patient not receiving antiviral treatment for hepatitis c
g8461
Patient receiving antiviral treatment for hepatitis c during the measurement period
g8464
Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined
g8465
High or very high risk of recurrence of prostate cancer
g8473
Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed
g8474
Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons) or (e.g., lack of drug availability, other reasons attributable to the health care system)
g8475
Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given
g8476
Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg
g8477
Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg
g8478
Blood pressure measurement not performed or documented, reason not given
g8482
Influenza immunization administered or previously received
g8483
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
g8484
Influenza immunization was not administered, reason not given
g8485
I intend to report the diabetes mellitus (dm) measures group
g8486
I intend to report the preventive care measures group
g8487
I intend to report the chronic kidney disease (ckd) measures group
g8489
I intend to report the coronary artery disease (cad) measures group
g8490
I intend to report the rheumatoid arthritis (ra) measures group
g8491
I intend to report the hiv/aids measures group
g8492
I intend to report the perioperative care measures group
g8493
I intend to report the back pain measures group
g8494
All quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient
g8495
All quality actions for the applicable measures in the chronic kidney disease (ckd) measures group have been performed for this patient
g8496
All quality actions for the applicable measures in the preventive care measures group have been performed for this patient
g8497
All quality actions for the applicable measures in the coronary artery bypass graft (cabg) measures group have been performed for this patient
g8498
All quality actions for the applicable measures in the coronary artery disease (cad) measures group have been performed for this patient
g8499
All quality actions for the applicable measures in the rheumatoid arthritis (ra) measures group have been performed for this patient
g8500
All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient
g8501
All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient
g8502
All quality actions for the applicable measures in the back pain measures group have been performed for this patient
g8506
Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
g8509
Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
g8510
Screening for depression is documented as negative, a follow-up plan is not required
g8511
Screening for depression documented as positive, follow-up plan not documented, reason not given
g8530
Autogenous av fistula received
g8531
Clinician documented that patient was not an eligible candidate for autogenous av fistula
g8532
Clinician documented that patient received vascular access other than autogenous av fistula, reason not given
g8535
Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter
g8536
No documentation of an elder maltreatment screen, reason not given
g8539
Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies on the date of functional outcome assessment, is documented
g8540
Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter
g8541
Functional outcome assessment using a standardized tool not documented, reason not given
g8542
Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required
g8543
Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given
g8544
I intend to report the coronary artery bypass graft (cabg) measures group
g8545
I intend to report the hepatitis c measures group
g8547
I intend to report the ischemic vascular disease (ivd) measures group
g8548
I intend to report the heart failure (hf) measures group
g8549
All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patient
g8551
All quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient
g8552
All quality actions for the applicable measures in the ischemic vascular disease (ivd) measures group have been performed for this patient
g8559
Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation
g8560
Patient has a history of active drainage from the ear within the previous 90 days
g8561
Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure
g8562
Patient does not have a history of active drainage from the ear within the previous 90 days
g8563
Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given
g8564
Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified)
g8565
Verification and documentation of sudden or rapidly progressive hearing loss
g8566
Patient is not eligible for the "referral for otologic evaluation for sudden or rapidly progressive hearing loss" measure
g8567
Patient does not have verification and documentation of sudden or rapidly progressive hearing loss
g8568
Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given
g8569
Prolonged postoperative intubation (> 24 hrs) required
g8570
Prolonged postoperative intubation (> 24 hrs) not required
g8571
Development of deep sternal wound infection/mediastinitis within 30 days postoperatively
g8572
No deep sternal wound infection/mediastinitis
g8573
Stroke following isolated cabg surgery
g8574
No stroke following isolated cabg surgery
g8575
Developed postoperative renal failure or required dialysis
g8576
No postoperative renal failure/dialysis not required
g8577
Re-exploration required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason
g8578
Re-exploration not required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason
g8579
Antiplatelet medication at discharge
g8580
Antiplatelet medication contraindicated
g8581
No antiplatelet medication at discharge
g8582
Beta-blocker at discharge
g8583
Beta-blocker contraindicated
g8584
No beta-blocker at discharge
g8585
Anti-lipid treatment at discharge
g8586
Anti-lipid treatment contraindicated
g8587
No anti-lipid treatment at discharge
g8593
Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)
g8594
Lipid profile not performed, reason not given
g8595
Most recent ldl-c < 100 mg/dl
g8597
Most recent ldl-c >= 100 mg/dl
g8598
Aspirin or another antiplatelet therapy used
g8599
Aspirin or another antiplatelet therapy not used, reason not given
g8600
Iv t-pa initiated within three hours (<= 180 minutes) of time last known well
g8601
Iv alteplase not initiated within three hours (<= 180 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention, patient received tenecteplase (tnk))
g8602
Iv t-pa not initiated within three hours (<= 180 minutes) of time last known well, reason not given
g8627
Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)
g8628
Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)
g8629
Documentation of order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)
g8630
Documentation that administration of prophylactic parenteral antibiotics was initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required), as ordered
g8631
Clinician documented that patient was not an eligible candidate for ordering prophylactic parenteral antibiotics to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)
g8632
Prophylactic parenteral antibiotics were not ordered to be given or given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required), reason not given
g8633
Pharmacologic therapy (other than minierals/vitamins) for osteoporosis prescribed
g8634
Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis
g8635
Pharmacologic therapy for osteoporosis was not prescribed, reason not given
g8645
I intend to report the asthma measures group
g8646
All quality actions for the applicable measures in the asthma measures group have been performed for this patient
g8647
Risk-adjusted functional status change residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
g8648
Risk-adjusted functional status change residual score for the knee impairment successfully calculated and the score was less than zero (< 0)
g8649
Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
g8650
Risk-adjusted functional status change residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
g8651
Risk-adjusted functional status change residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
g8652
Risk-adjusted functional status change residual score for the hip impairment successfully calculated and the score was less than zero (< 0)
g8653
Risk-adjusted functional status change residual scores for the hip impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
g8654
Risk-adjusted functional status change residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
g8655
Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment successfully calculated and the score was equal to zero (0) or greater than zero ( > 0)
g8656
Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0)
g8657
Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
g8658
Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given
g8659
Risk-adjusted functional status change residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
g8660
Risk-adjusted functional status change residual score for the low back impairment successfully calculated and the score was less than zero (< 0)
g8661
Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
g8662
Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the low back fs prom at initial evaluation and/or near discharge, reason not given
g8663
Risk-adjusted functional status change residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
g8664
Risk-adjusted functional status change residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0)
g8665
Risk-adjusted functional status change residual score for the shoulder impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
g8666
Risk-adjusted functional status change residual score for the shoulder impairment not measured because the patient did not complete the shoulder fs prom at initial evaluation and/or near discharge, reason not given
g8667
Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
g8668
Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0)
g8669
Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
g8670
Risk-adjusted functional status change residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the elbow/wrist/hand fs prom at initial evaluation and/or near discharge, reason not given
g8671
Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)
g8672
Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment successfully calculated and the score was less than zero (< 0)
g8673
Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate
g8674
Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs or other general orthopedic impairment not measured because the patient did not complete the general orthopedic fs prom at initial evaluation and/or near discharge, reason not given
g8682
Lvf testing documented as being performed prior to discharge or in the previous 12 months
g8683
Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason
g8685
Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given
g8694
Left ventricular ejection fraction (lvef) < 40% or documentation of moderate or severe lvsd
g8696
Antithrombotic therapy prescribed at discharge
g8697
Antithrombotic therapy not prescribed for documented reasons (e.g., patient had stroke during hospital stay, patient expired during inpatient stay, other medical reason(s)); (e.g., patient left against medical advice, other patient reason(s))
g8698
Antithrombotic therapy was not prescribed at discharge, reason not given
g8699
Rehabilitation services (occupational, physical or speech) ordered at or prior to discharge
g8700
Rehabilitation services (occupational, physical or speech) not indicated at or prior to discharge
g8701
Rehabilitation services were not ordered, reason not otherwise specified
g8702
Documentation that prophylactic antibiotics were given within 4 hours prior to surgical incision or intraoperatively
g8703
Documentation that prophylactic antibiotics were neither given within 4 hours prior to surgical incision nor intraoperatively
g8704
12-lead electrocardiogram (ecg) performed
g8705
Documentation of medical reason(s) for not performing a 12-lead electrocardiogram (ecg)
g8706
Documentation of patient reason(s) for not performing a 12-lead electrocardiogram (ecg)
g8707
12-lead electrocardiogram (ecg) not performed, reason not given
g8708
Patient not prescribed or dispensed antibiotic
g8709
Uri episodes when the patient had competing diagnoses on or three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti, and acne)
g8710
Patient prescribed or dispensed antibiotic
g8711
Prescribed or dispensed antibiotic on or within 3 days after the episode date
g8712
Antibiotic not prescribed or dispensed
g8713
Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v])
g8714
Hemodialysis treatment performed exactly three times per week for > 90 days
g8717
Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason not given
g8718
Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt] / volume [v])
g8720
Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v])
g8721
Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report
g8722
Documentation of medical reason(s) for not including the pt category, the pn category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; non-carcinomasanal canal)
g8723
Specimen site is other than anatomic location of primary tumor
g8724
Pt category, pn category and histologic grade were not documented in the pathology report, reason not given
g8725
Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total cholesterol)
g8726
Clinician has documented reason for not performing fasting lipid profile (e.g., patient declined, other patient reasons)
g8728
Fasting lipid profile not performed, reason not given
g8730
Pain assessment documented as positive using a standardized tool and a follow-up plan is documented
g8731
Pain assessment using a standardized tool is documented as negative, no follow-up plan required
g8732
No documentation of pain assessment, reason not given
g8733
Elder maltreatment screen documented as positive and a follow-up plan is documented
g8734
Elder maltreatment screen documented as negative, no follow-up required
g8735
Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given
g8736
Most current ldl-c <100mg/dl
g8737
Most current ldl-c >=100mg/dl
g8738
Left ventricular ejection fraction (lvef) < 40% or documentation of severely or moderately depressed left ventricular systolic function
g8739
Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function
g8740
Left ventricular ejection fraction (lvef) not performed or assessed, reason not given
g8749
Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma)
g8751
Smoking status and exposure to second hand smoke in the home not assessed, reason not given
g8752
Most recent systolic blood pressure < 140 mmhg
g8753
Most recent systolic blood pressure >= 140 mmhg
g8754
Most recent diastolic blood pressure < 90 mmhg
g8755
Most recent diastolic blood pressure >= 90 mmhg
g8756
No documentation of blood pressure measurement, reason not given
g8757
All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient
g8758
All quality actions for the applicable measures in the inflammatory bowel disease (ibd) measures group have been performed for this patient
g8759
All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient
g8761
All quality actions for the applicable measures in the dementia measures group have been performed for this patient
g8762
All quality actions for the applicable measures in the parkinson's disease measures group have been performed for this patient
g8763
All quality actions for the applicable measures in the hypertension (htn) measures group have been performed for this patient
g8764
All quality actions for the applicable measures in the cardiovascular prevention measures group have bee performed for this patient
g8765
All quality actions for the applicable measures in the cataract measures group have been performed for this patient
g8767
Lipid panel results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c)
g8768
Documentation of medical reason(s) for not performing lipid profile (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
g8769
Lipid profile not performed, reason not given
g8770
Urine protein test result documented and reviewed
g8771
Documentation of diagnosis of chronic kidney disease
g8772
Documentation of medical reason(s) for not performing urine protein test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not cllinically appropriate)
g8773
Urine protein test was not performed, reason not given
g8774
Serum creatinine test result documented and reviewed
g8775
Documentation of medical reason(s) for not performing serum creatinine test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
g8776
Serum creatinine test not performed, reason not given
g8777
Diabetes screening test performed
g8778
Documentation of medical reason(s) for not performing diabetes screening test (e.g., patients with a diagnosis of diabetes, or with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
g8779
Diabetes screening test not performed, reason not given
g8780
Counseling for diet and physical activity performed
g8781
Documentation of medical reason(s) for patient not receiving counseling for diet and physical activity (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
g8782
Counseling for diet and physical activity not performed, reason not given
g8783
Normal blood pressure reading documented, follow-up not required
g8784
Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation)
g8785
Blood pressure reading not documented, reason not given
g8797
Specimen site other than anatomic location of esophagus
g8798
Specimen site other than anatomic location of prostate
g8806
Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented
g8807
Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has visited the ed multiple times within 72 hours, patient has a documented intrauterine pregnancy [iup])
g8808
Trans-abdominal or trans-vaginal ultrasound not performed, reason not given
g8809
Rh-immunoglobulin (rhogam) ordered
g8810
Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal)
g8811
Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given
g8815
Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease)
g8816
Statin medication prescribed at discharge
g8817
Statin therapy not prescribed at discharge, reason not given
g8818
Patient discharge to home no later than post-operative day #7
g8825
Patient not discharged to home by post-operative day #7
g8826
Patient discharge to home no later than post-operative day #2 following evar
g8833
Patient not discharged to home by post-operative day #2 following evar
g8834
Patient discharged to home no later than post-operative day #2 following cea
g8838
Patient not discharged to home by post-operative day #2 following cea
g8839
Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness
g8840
Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy)
g8841
Sleep apnea symptoms not assessed, reason not given
g8842
Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) measured at the time of initial diagnosis
g8843
Documentation of reason(s) for not measuring an apnea hypopnea index (ahi) or a respiratory disturbance index (rdi) at the time of initial diagnosis (e.g., psychiatric disease, dementia, patient declined, financial, insurance coverage, test ordered but not yet completed)
g8844
Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) not measured at the time of initial diagnosis, reason not given
g8845
Positive airway pressure therapy prescribed
g8846
Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater)
g8848
Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15)
g8849
Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage)
g8850
Positive airway pressure therapy not prescribed, reason not given
g8851
Objective measurement of adherence to positive airway pressure therapy, documented
g8852
Positive airway pressure therapy prescribed
g8853
Positive airway pressure therapy not prescribed
g8854
Documentation of reason(s) for not objectively measuring adherence to positive airway pressure therapy (e.g., patient didn't bring data from continous positive airway pressure [cpap], therapy not yet initiated, not available on machine)
g8855
Objective measurement of adherence to positive airway pressure therapy not performed, reason not given
g8856
Referral to a physician for an otologic evaluation performed
g8857
Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)
g8858
Referral to a physician for an otologic evaluation not performed, reason not given
g8859
Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
g8860
Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
g8861
Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
g8862
Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
g8863
Patients not assessed for risk of bone loss, reason not given
g8864
Pneumococcal vaccine administered or previously received
g8865
Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)
g8866
Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)
g8867
Pneumococcal vaccine not administered or previously received, reason not given
g8868
Patients receiving a first course of anti-tnf therapy
g8869
Patient has documented immunity to hepatitis b and initiating anti-tnf therapy
g8870
Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy
g8871
Patient not receiving a first course of anti-tnf therapy
g8872
Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
g8873
Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site)
g8874
Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
g8875
Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method
g8876
Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician)
g8877
Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given
g8878
Sentinel lymph node biopsy procedure performed
g8879
Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer
g8880
Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)
g8881
Stage of breast cancer is greater than t1n0m0 or t2n0m0
g8882
Sentinel lymph node biopsy procedure not performed, reason not given
g8883
Biopsy results reviewed, communicated, tracked and documented
g8884
Clinician documented reason that patient's biopsy results were not reviewed
g8885
Biopsy results not reviewed, communicated, tracked or documented
g8886
Most recent blood pressure under control
g8887
Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
g8888
Most recent blood pressure not under control, results documented and reviewed
g8889
No documentation of blood pressure measurement, reason not given
g8890
Most recent ldl-c under control, results documented and reviewed
g8891
Documentation of medical reason(s) for most recent ldl-c not under control (e.g., patients with palliative goals for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
g8892
Documentation of medical reason(s) for not performing ldl-c test (e.g. patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
g8893
Most recent ldl-c not under control, results documented and reviewed
g8894
Ldl-c not performed, reason not given
g8895
Oral aspirin or other antithrombotic therapy prescribed
g8896
Documentation of medical reason(s) for not prescribing oral aspirin or other antithrombotic therapy (e.g., patient documented to be low risk or patient with terminal illness or treatment of hypertension with standard treatment goals is not clinically appropriate, or for whom risk of aspirin or other antithrombotic therapy exceeds potential benefits such as for individuals whose blood pressure is poorly controlled)
g8897
Oral aspirin or other antithrombotic therapy was not prescribed, reason not given
g8898
I intend to report the chronic obstructive pulmonary disease (copd) measures group
g8899
I intend to report the inflammatory bowel disease (ibd) measures group
g8900
I intend to report the sleep apnea measures group
g8902
I intend to report the dementia measures group
g8903
I intend to report the parkinson's disease measures group
g8904
I intend to report the hypertension (htn) measures group
g8905
I intend to report the cardiovascular prevention measures group
g8906
I intend to report the cataract measures group
g8907
Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility
g8908
Patient documented to have received a burn prior to discharge
g8909
Patient documented not to have received a burn prior to discharge
g8910
Patient documented to have experienced a fall within asc
g8911
Patient documented not to have experienced a fall within ambulatory surgical center
g8912
Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
g8913
Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
g8914
Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc
g8915
Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc
g8916
Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time
g8917
Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time
g8918
Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis
g8923
Left ventricular ejection fraction (lvef) < 40% or documentation of moderately or severely depressed left ventricular systolic function
g8924
Spirometry test results demonstrate fev1/fvc < 70%, fev1 < 60% predicted and patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)
g8925
Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms
g8926
Spirometry test not performed or documented, reason not given
g8927
Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer
g8928
Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons)
g8929
Adjuvant chemotherapy not prescribed or previously received, reason not given
g8930
Assessment of depression severity at the initial evaluation
g8931
Assessment of depression severity not documented, reason not given
g8932
Suicide risk assessed at the initial evaluation
g8933
Suicide risk not assessed at the initial evaluation, reason not given
g8934
Left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function
g8935
Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
g8936
Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons) or (eg, lack of drug availability, other reasons attributable to the health care system)
g8937
Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given
g8938
Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible
g8939
Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter
g8940
Screening for depression documented as positive, a follow-up plan not completed, documented reason
g8941
Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounter
g8942
Functional outcomes assessment using a standardized tool is documented within the previous 30 days and care plan, based on identified deficiencies on the date of the functional outcome assessment, is documented
g8943
Ldl-c result not present or not within 12 months prior
g8944
Ajcc melanoma cancer stage 0 through iic melanoma
g8946
Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells)
g8947
One or more neuropsychiatric symptoms
g8948
No neuropsychiatric symptoms
g8949
Documentation of patient reason(s) for patient not receiving counseling for diet and physical activity (e.g., patient is not willing to discuss diet or exercise interventions to help control blood pressure, or the patient said he/she refused to make these changes)
g8950
Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
g8951
Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible
g8952
Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
g8953
All quality actions for the applicable measures in the oncology measures group have been performed for this patient
g8955
Most recent assessment of adequacy of volume management documented
g8956
Patient receiving maintenance hemodialysis in an outpatient dialysis facility
g8957
Patient not receiving maintenance hemodialysis in an outpatient dialysis facility
g8958
Assessment of adequacy of volume management not documented, reason not given
g8959
Clinician treating major depressive disorder communicates to clinician treating comorbid condition
g8960
Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given
g8961
Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery
g8962
Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery
g8963
Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years
g8964
Cardiac stress imaging test performed primarily for any other reason than monitoring of asymptomatic patient who had pci within 2 years (e.g., symptomatic patient, patient greater than 2 years since pci, initial evaluation, etc)
g8965
Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment
g8966
Cardiac stress imaging test performed on symptomatic or higher than low chd risk patient or for any reason other than initial detection and risk assessment
g8967
Fda approved oral anticoagulant is prescribed
g8968
Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant to a patient with a cha2ds2-vasc score of 0 or 1 for men; or 0, 1, or 2 for women (e.g., present or planned atrial appendage occlusion or ligation)
g8969
Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)
g8970
No risk factors or one moderate risk factor for thromboembolism
g8971
Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given
g8972
One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism
g8973
Most recent hemoglobin (hgb) level < 10 g/dl
g8974
Hemoglobin level measurement not documented, reason not given
g8975
Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons)
g8976
Most recent hemoglobin (hgb) level >= 10 g/dl
g8977
I intend to report the oncology measures group
g8978
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals
g8979
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g8980
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting
g8981
Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals
g8982
Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g8983
Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting
g8984
Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals
g8985
Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g8986
Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting
g8987
Self care functional limitation, current status, at therapy episode outset and at reporting intervals
g8988
Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g8989
Self care functional limitation, discharge status, at discharge from therapy or to end reporting
g8990
Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals
g8991
Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g8992
Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting
g8993
Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals
g8994
Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g8995
Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting
g8996
Swallowing functional limitation, current status at therapy episode outset and at reporting intervals
g8997
Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g8998
Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting
g8999
Motor speech functional limitation, current status at therapy episode outset and at reporting intervals
g9001
Coordinated care fee, initial rate
g9002
Coordinated care fee, maintenance rate
g9003
Coordinated care fee, risk adjusted high, initial
g9004
Coordinated care fee, risk adjusted low, initial
g9005
Coordinated care fee, risk adjusted maintenance
g9006
Coordinated care fee, home monitoring
g9007
Coordinated care fee, scheduled team conference
g9008
Coordinated care fee, physician coordinated care oversight services
g9009
Coordinated care fee, risk adjusted maintenance, level 3
g9010
Coordinated care fee, risk adjusted maintenance, level 4
g9011
Coordinated care fee, risk adjusted maintenance, level 5
g9012
Other specified case management service not elsewhere classified
g9013
Esrd demo basic bundle level i
g9014
Esrd demo expanded bundle including venous access and related services
g9016
Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only]
g9017
Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
g9018
Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project)
g9019
Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project)
g9020
Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
g9033
Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project)
g9034
Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project)
g9035
Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project)
g9036
Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project)
g9050
Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project)
g9051
Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project)
g9052
Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
g9053
Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
g9054
Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project)
g9055
Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project)
g9056
Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project)
g9057
Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project)
g9058
Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project)
g9059
Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project)
g9060
Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project)
g9061
Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project)
g9062
Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project)
g9063
Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9064
Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9065
Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9066
Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
g9067
Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9068
Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9069
Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
g9070
Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9071
Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9072
Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9073
Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9074
Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9075
Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
g9077
Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9078
Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9079
Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9080
Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project)
g9083
Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9084
Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9085
Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9086
Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9087
Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
g9088
Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
g9089
Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9090
Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9091
Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9092
Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project)
g9093
Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9094
Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
g9095
Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9096
Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9097
Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9098
Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
g9099
Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9100
Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project)
g9101
Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
g9102
Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
g9103
Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
g9104
Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9105
Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9106
Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
g9107
Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
g9108
Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9109
Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9110
Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9111
Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
g9112
Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9113
Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9114
Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9115
Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
g9116
Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project)
g9117
Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9123
Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
g9124
Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
g9125
Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
g9126
Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
g9128
Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project)
g9129
Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project)
g9130
Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9131
Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
g9132
Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project)
g9133
Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project)
g9134
Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project)
g9135
Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project)
g9136
Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project)
g9137
Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project)
g9138
Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project)
g9139
Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project)
g9140
Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours
g9143
Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
g9147
Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration
g9148
National committee for quality assurance - level 1 medical home
g9149
National committee for quality assurance - level 2 medical home
g9150
National committee for quality assurance - level 3 medical home
g9151
Mapcp demonstration - state provided services
g9152
Mapcp demonstration - community health teams
g9153
Mapcp demonstration - physician incentive pool
g9156
Evaluation for wheelchair requiring face to face visit with physician
g9157
Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes
g9158
Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
g9159
Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals
g9160
Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g9161
Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
g9162
Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals
g9163
Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g9164
Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting
g9165
Attention functional limitation, current status at therapy episode outset and at reporting intervals
g9166
Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g9167
Attention functional limitation, discharge status at discharge from therapy or to end reporting
g9168
Memory functional limitation, current status at therapy episode outset and at reporting intervals
g9169
Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g9170
Memory functional limitation, discharge status at discharge from therapy or to end reporting
g9171
Voice functional limitation, current status at therapy episode outset and at reporting intervals
g9172
Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g9173
Voice functional limitation, discharge status at discharge from therapy or to end reporting
g9174
Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals
g9175
Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g9176
Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting
g9186
Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
g9187
Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code
g9188
Beta-blocker therapy not prescribed, reason not given
g9189
Beta-blocker therapy prescribed or currently being taken
g9190
Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons)
g9191
Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons)
g9192
Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)
g9193
Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression
g9194
Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase
g9195
Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase
g9196
Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))
g9197
Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis
g9198
Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given
g9199
Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s))
g9200
Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given
g9201
Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission
g9202
Patients with a positive hepatitis c antibody test
g9203
Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
g9204
Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
g9205
Patient starting antiviral treatmentfor hepatitis c during the measurement period
g9206
Patient starting antiviral treatment for hepatitis c during the measurement period
g9207
Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
g9208
Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
g9209
Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment
g9210
Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons)
g9211
Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given
g9212
Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
g9213
Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
g9214
Cd4+ cell count or cd4+ cell percentage results documented
g9215
Cd4+ cell count or percentage not documented as performed, reason not given
g9216
Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
g9217
Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given
g9218
Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given
g9219
Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
g9220
Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
g9221
Pneumocystis jiroveci pneumonia prophlaxis prescribed
g9222
Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3
g9223
Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
g9224
Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)
g9225
Foot exam was not performed, reason not given
g9226
Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed)
g9227
Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter
g9228
Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings)
g9229
Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception)
g9230
Chlamydia, gonorrhea, and syphilis not screened, reason not given
g9231
Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period
g9232
Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason (e.g., patient is unable to communicate the diagnosis of a comorbid condition; the patient is unwilling to communicate the diagnosis of a comorbid condition; or the patient is unaware of the comorbid condition, or any other specified patient reason)
g9233
All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient
g9234
I intend to report the total knee replacement measures group
g9235
All quality actions for the applicable measures in the general surgery measures group have been performed for this patient
g9236
All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient
g9237
I intend to report the general surgery measures group
g9238
I intend to report the optimizing patient exposure to ionizing radiation measures group
g9239
Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing arteriovenous fistula (avf)/arteriovenous graft (avg), time-limited trial of hemodialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons)
g9240
Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
g9241
Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated
g9242
Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
g9243
Documentation of viral load less than 200 copies/ml
g9244
Antiretroviral thereapy not prescribed
g9245
Antiretroviral therapy prescribed
g9246
Patient did not have at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits
g9247
Patient had at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits
g9248
Patient did not have a medical visit in the last 6 months
g9249
Patient had a medical visit in the last 6 months
g9250
Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment
g9251
Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment
g9252
Adenoma(s) or other neoplasm detected during screening colonoscopy
g9253
Adenoma(s) or other neoplasm not detected during screening colonoscopy
g9254
Documentation of patient discharged to home later than post-operative day 2 following cas
g9255
Documentation of patient discharged to home no later than post operative day 2 following cas
g9256
Documentation of patient death following cas
g9257
Documentation of patient stroke following cas
g9258
Documentation of patient stroke following cea
g9259
Documentation of patient survival and absence of stroke following cas
g9260
Documentation of patient death following cea
g9261
Documentation of patient survival and absence of stroke following cea
g9262
Documentation of patient death in the hospital following endovascular aaa repair
g9263
Documentation of patient discharged alive following endovascular aaa repair
g9264
Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons)
g9265
Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access
g9266
Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access
g9267
Documentation of patient with one or more complications or mortality within 30 days
g9268
Documentation of patient with one or more complications within 90 days
g9269
Documentation of patient without one or more complications and without mortality within 30 days
g9270
Documentation of patient without one or more complications within 90 days
g9271
Ldl value < 100
g9272
Ldl value >= 100
g9273
Blood pressure has a systolic value of < 140 and a diastolic value of < 90
g9274
Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90
g9275
Documentation that patient is a current non-tobacco user
g9276
Documentation that patient is a current tobacco user
g9277
Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux)
g9278
Documentation that the patient is not on daily aspirin or anti-platelet regimen
g9279
Pneumococcal screening performed and documentation of vaccination received prior to discharge
g9280
Pneumococcal vaccination not administered prior to discharge, reason not specified
g9281
Screening performed and documentation that vaccination not indicated/patient refusal
g9282
Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons)
g9283
Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
g9284
Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation
g9285
Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer
g9286
Antibiotic regimen prescribed within 10 days after onset of symptoms
g9287
Antibiotic regimen not prescribed within 10 days after onset of symptoms
g9288
Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons)
g9289
Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
g9290
Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation
g9291
Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos
g9292
Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons)
g9293
Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
g9294
Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
g9295
Specimen site other than anatomic cutaneous location
g9296
Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure
g9297
Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure, not documented, reason not given
g9298
Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke)
g9299
Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given)
g9300
Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used)
g9301
Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet
g9302
Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given
g9303
Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant, reason not given
g9304
Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant
g9305
Intervention for presence of leak of endoluminal contents through an anastomosis not required
g9306
Intervention for presence of leak of endoluminal contents through an anastomosis required
g9307
No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
g9308
Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
g9309
No unplanned hospital readmission within 30 days of principal procedure
g9310
Unplanned hospital readmission within 30 days of principal procedure
g9311
No surgical site infection
g9312
Surgical site infection
g9313
Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason
g9314
Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given
g9315
Documentation amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis
g9316
Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family
g9317
Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed
g9318
Imaging study named according to standardized nomenclature
g9319
Imaging study not named according to standardized nomenclature, reason not given
g9320
Documentation of medical reason(s) for not naming ct studies according to a standardized nomenclature provided (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
g9321
Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion) studies documented in the 12-month period prior to the current study
g9322
Count of previous ct and cardiac nuclear medicine (myocardial perfusion) studies not documented in the 12-month period prior to the current study, reason not given
g9323
Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
g9324
All necessary data elements not included, reason not given
g9325
Ct studies not reported to a radiation dose index registry due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
g9326
Ct studies performed not reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements, reason not given
g9327
Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements
g9328
Dicom format image data availability not documented in final report due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
g9329
Dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given
g9340
Final report documented that dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study
g9341
Search conducted for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed
g9342
Search not conducted prior to an imaging study being performed for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive, reason not given
g9343
Due to medical reasons, search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
g9344
Due to system reasons search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., non-affiliated external healthcare facilities or entities does not have archival abilities through a shared archival system)
g9345
Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors
g9346
Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
g9347
Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given
g9348
Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons
g9349
Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis
g9350
Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis
g9351
More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis
g9352
More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given
g9353
More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with complications, second ct obtained prior to surgery, other medical reasons)
g9354
One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis
g9355
Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation)
g9356
Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation)
g9357
Post-partum screenings, evaluations and education performed
g9358
Post-partum screenings, evaluations and education not performed
g9359
Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier
g9360
No documentation of negative or managed positive tb screen
g9361
Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]
g9362
Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record
g9363
Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record
g9364
Sinusitis caused by, or presumed to be caused by, bacterial infection
g9365
One high-risk medication ordered
g9366
One high-risk medication not ordered
g9367
At least two orders for high-risk medications from the same drug class
g9368
At least two orders for high-risk medications from the same drug class not ordered
g9369
Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater
g9370
Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater
g9376
Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery
g9377
Patient did not have the retina attached after 6 months following only one surgery
g9378
Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month)
g9379
Patient did not achieve flat retinas six months post surgery
g9380
Patient offered assistance with end of life issues during the measurement period
g9381
Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period
g9382
Patient not offered assistance with end of life issues during the measurement period
g9383
Patient received screening for hcv infection within the 12 month reporting period
g9384
Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)
g9385
Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons)
g9386
Screening for hcv infection not received within the 12 month reporting period, reason not given
g9389
Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
g9390
No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
g9391
Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
g9392
Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
g9393
Patient with an initial phq-9 score greater than nine who achieves remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of less than five
g9394
Patient who had a diagnosis of bipolar disorder or personality disorder, death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement or assessment period
g9395
Patient with an initial phq-9 score greater than nine who did not achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score greater than or equal to five
g9396
Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days)
g9399
Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment
g9400
Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons
g9401
No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
g9402
Patient received follow-up within 30 days after discharge
g9403
Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up)
g9404
Patient did not receive follow-up on the date of discharge or within 30 days after discharge
g9405
Patient received follow-up within 7 days after discharge
g9406
Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up)
g9407
Patient did not receive follow-up on or within 7 days after discharge
g9408
Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days
g9409
Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days
g9410
Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
g9411
Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
g9412
Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
g9413
Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
g9414
Patient had one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient's 11th and 13th birthdays
g9415
Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient's 11th and 13th birthdays
g9416
Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays
g9417
Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays
g9418
Primary non-small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation
g9419
Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons)
g9420
Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer
g9421
Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation
g9422
Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos)
g9423
Documentation of medical reason for not including pt category, pn category and histologic type [for patient with appropriate exclusion criteria (e.g., metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)]
g9424
Specimen site other than anatomic location of lung, or classified as nsclc-nos
g9425
Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma)
g9426
Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients
g9427
Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients
g9428
Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
g9429
Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons)
g9430
Specimen site other than anatomic cutaneous location
g9431
Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
g9432
Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented
g9433
Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period
g9434
Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given
g9435
Aspirin prescribed at discharge
g9436
Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
g9437
Aspirin not prescribed at discharge
g9438
P2y inhibitor prescribed at discharge
g9439
P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
g9440
P2y inhibitor not prescribed at discharge
g9441
Statin prescribed at discharge
g9442
Statin not prescribed for documented reasons (e.g., allergy, medical intolerance)
g9443
Statin not prescribed at discharge
g9448
Patients who were born in the years 1945 to 1965
g9449
History of receiving blood transfusions prior to 1992
g9450
History of injection drug use
g9451
Patient received one-time screening for hcv infection
g9452
Documentation of medical reason(s) for not receiving one-time screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [ie, ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)
g9453
Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons)
g9454
One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given
g9455
Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc
g9456
Documentation of medical or patient reason(s) for not ordering or performing screening for hcc. medical reason: comorbid medical conditions with expected survival < 5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons; patient reasons: patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment)
g9457
Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period
g9458
Patient documented as tobacco user and received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user
g9459
Currently a tobacco non-user
g9460
Tobacco assessment or tobacco cessation intervention not performed, reason not given
g9463
I intend to report the sinusitis measures group
g9464
All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient
g9465
I intend to report the acute otitis externa (aoe) measures group
g9466
All quality actions for the applicable measures in the aoe measures group have been performed for this patient
g9467
Patient who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills within the last twelve months
g9468
Patient not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills
g9469
Patients who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 90 or greater consecutive days or a single prescription equating to 900 mg prednisone or greater for all fills
g9470
Patients not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills
g9471
Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented
g9472
Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered and documented, no review of systems and no medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
g9473
Services performed by chaplain in the hospice setting, each 15 minutes
g9474
Services performed by dietary counselor in the hospice setting, each 15 minutes
g9475
Services performed by other counselor in the hospice setting, each 15 minutes
g9476
Services performed by volunteer in the hospice setting, each 15 minutes
g9477
Services performed by care coordinator in the hospice setting, each 15 minutes
g9478
Services performed by other qualified therapist in the hospice setting, each 15 minutes
g9479
Services performed by qualified pharmacist in the hospice setting, each 15 minutes
g9480
Admission to medicare care choice model program (mccm)
g9481
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9482
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9483
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9484
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9485
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9486
Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9487
Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9488
Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9489
Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9490
Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code
g9496
Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
g9497
Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery
g9498
Antibiotic regimen prescribed
g9499
Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period
g9500
Radiation exposure indices, or exposure time and number of fluorographic images in final report for procedures using fluoroscopy, documented
g9501
Radiation exposure indices, or exposure time and number of fluorographic images not documented in final report for procedure using fluoroscopy, reason not given
g9502
Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)
g9503
Patient taking tamsulosin hydrochloride
g9504
Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
g9505
Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
g9506
Biologic immune response modifier prescribed
g9507
Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
g9508
Documentation that the patient is not on a statin medication
g9509
Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
g9510
Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5
g9511
Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
g9512
Individual had a pdc of 0.8 or greater
g9513
Individual did not have a pdc of 0.8 or greater
g9514
Patient required a return to the operating room within 90 days of surgery
g9515
Patient did not require a return to the operating room within 90 days of surgery
g9516
Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery
g9517
Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given
g9518
Documentation of active injection drug use
g9519
Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
g9520
Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
g9521
Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
g9522
Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given
g9523
Patient discontinued from hemodialysis or peritoneal dialysis
g9524
Patient was referred to hospice care
g9525
Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)
g9526
Patient was not referred to hospice care, reason not given
g9529
Patient with minor blunt head trauma had an appropriate indication(s) for a head ct
g9530
Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
g9531
Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar
g9532
Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
g9533
Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct
g9534
Advanced brain imaging (cta, ct, mra or mri) was not ordered
g9535
Patients with a normal neurological examination
g9536
Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms)
g9537
Imaging needed as part of a clinical trial; or other clinician ordered the study
g9538
Advanced brain imaging (cta, ct, mra or mri) was ordered
g9539
Intent for potential removal at time of placement
g9540
Patient alive 3 months post procedure
g9541
Filter removed within 3 months of placement
g9542
Documented re-assessment for the appropriateness of filter removal within 3 months of placement
g9543
Documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement
g9544
Patients that do not have the filter removed, documented re-assessment for the appropriateness of filter removal, or documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement
g9547
Cystic renal lesion that is simple appearing (bosniak i or ii) , or adrenal lesion less than or equal to 1.0 cm or adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced ct or washout protocol ct, or mri with in- and opposed-phase sequences or other equivalent institutional imaging protocols
g9548
Final reports for imaging studies stating no follow-up imaging is recommended
g9549
Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has lymphadenopathy, signs of metastasis or an active diagnosis or history of cancer, and other medical reason(s))
g9550
Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up
g9551
Final reports for imaging studies without an incidentally found lesion noted
g9552
Incidental thyroid nodule < 1.0 cm noted in report
g9553
Prior thyroid disease diagnosis
g9554
Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended
g9555
Documentation of medical reason(s) for recommending follow up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s))
g9556
Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended
g9557
Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found
g9558
Patient treated with a beta-lactam antibiotic as definitive therapy
g9559
Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics)
g9560
Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given
g9561
Patients prescribed opiates for longer than six weeks
g9562
Patients who had a follow-up evaluation conducted at least every three months during opioid therapy
g9563
Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy
g9572
Index date phq-score greater than 9 documented during the twelve month denominator identification period
g9573
Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five
g9574
Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was not assessed or is greater than or equal to five
g9577
Patients prescribed opiates for longer than six weeks
g9578
Documentation of signed opioid treatment agreement at least once during opioid therapy
g9579
No documentation of signed an opioid treatment agreement at least once during opioid therapy
g9580
Door to puncture time of 90 minutes or less
g9581
Door to puncture time of greater than 2 hours for reasons documented by clinician (e.g., patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment; hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment)
g9582
Door to puncture time of greater than 90 minutes, no reason given
g9583
Patients prescribed opiates for longer than six weeks
g9584
Patient evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least once during opioid therapy
g9585
Patient not evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at least once during opioid therapy
g9593
Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules
g9594
Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
g9595
Patient has documentation of ventricular shunt, brain tumor, or coagulopathy
g9596
Pediatric patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
g9597
Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules
g9598
Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
g9599
Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
g9600
Symptomatic aaas that required urgent/emergent (non-elective) repair
g9601
Patient discharge to home no later than post-operative day #7
g9602
Patient not discharged to home by post-operative day #7
g9603
Patient survey score improved from baseline following treatment
g9604
Patient survey results not available
g9605
Patient survey score did not improve from baseline following treatment
g9606
Intraoperative cystoscopy performed to evaluate for lower tract injury
g9607
Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death
g9608
Intraoperative cystoscopy not performed to evaluate for lower tract injury
g9609
Documentation of an order for anti-platelet agents
g9610
Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents
g9611
Order for anti-platelet agents was not documented in the patient's record, reason not given
g9612
Photodocumentation of two or more cecal landmarks to establish a complete examination
g9613
Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.)
g9614
Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination
g9615
Preoperative assessment documented
g9616
Documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery)
g9617
Preoperative assessment not documented, reason not given
g9618
Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
g9619
Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy)
g9620
Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given
g9621
Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling
g9622
Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
g9623
Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
g9624
Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user, reason not given
g9625
Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery
g9626
Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury)
g9627
Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
g9628
Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery
g9629
Documented medical reasons for not reporting bowel injury (e.g., gynecologic or other pelvic malignancy documented, planned (e.g., not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury)
g9630
Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
g9631
Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
g9632
Documented medical reasons for not reporting ureter injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of ureter injury)
g9633
Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
g9634
Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved
g9635
Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the hrqol survey, patient has the inability to read and/or write in order to complete the hrqol questionnaire)
g9636
Health-related quality of life not assessed with tool during at least two visits or quality of life score declined
g9637
Final reports with documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)
g9638
Final reports without documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)
g9639
Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure
g9640
Documentation of planned hybrid or staged procedure
g9641
Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure
g9642
Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana)
g9643
Elective surgery
g9644
Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure
g9645
Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure
g9646
Patients with 90 day mrs score of 0 to 2
g9647
Patients in whom mrs score could not be obtained at 90 day follow-up
g9648
Patients with 90 day mrs score greater than 2
g9649
Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi))
g9650
Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
g9651
Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) or psoriasis assessment tool not documented
g9652
Patient has been treated with a systemic or biologic medication for psoriasis for at least six months
g9653
Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months
g9654
Monitored anesthesia care (mac)
g9655
A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used
g9656
Patient transferred directly from anesthetizing location to pacu or other non-icu location
g9657
Transfer of care during an anesthetic or to the intensive care unit
g9658
A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used
g9659
Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits
g9660
Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits)
g9661
Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions
g9662
Previously diagnosed or have an active diagnosis of clinical ascvd, including ascvd procedure
g9663
Any ldl-c laboratory test result >= 190 mg/dl
g9664
Patients who are currently statin therapy users or received an order (prescription) for statin therapy
g9665
Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy
g9666
Patient's highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl
g9667
Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy)
g9669
I intend to report the multiple chronic conditions measures group
g9670
All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient
g9671
I intend to report the diabetic retinopathy measures group
g9672
All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient
g9673
I intend to report the cardiovascular prevention measures group
g9674
Patients with clinical ascvd diagnosis
g9675
Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl
g9676
Patients aged 40 to 75 years at the beginning of the measurement period with type 1 or type 2 diabetes and with an ldl-c result of 70-189 mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period
g9677
All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient
g9678
Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation agreement
g9679
This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary
g9680
This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary
g9681
This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary
g9682
This code is for the onsite acute care treatment a nursing facility resident with a skin infection; may only be billed once per day per beneficiary
g9683
Facility service(s) for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder. (may only be billed once per day per beneficiary). this service is for a demonstration project
g9684
This code is for the onsite acute care treatment of a nursing facility resident for a uti; may only be billed once per day per beneficiary
g9685
Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project
g9686
Onsite nursing facility conference, that is separate and distinct from an evaluation and management visit, including qualified practitioner and at least one member of the nursing facility interdisciplinary care team
g9687
Hospice services provided to patient any time during the measurement period
g9688
Patients using hospice services any time during the measurement period
g9689
Patient admitted for performance of elective carotid intervention
g9690
Patient receiving hospice services any time during the measurement period
g9691
Patient had hospice services any time during the measurement period
g9692
Hospice services received by patient any time during the measurement period
g9693
Patient use of hospice services any time during the measurement period
g9694
Hospice services utilized by patient any time during the measurement period
g9695
Long-acting inhaled bronchodilator prescribed
g9696
Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator
g9697
Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator
g9698
Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator
g9699
Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified
g9700
Patients who use hospice services any time during the measurement period
g9701
Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established
g9702
Patients who use hospice services any time during the measurement period
g9703
Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date, or had an active prescription on the episode date
g9704
Ajcc breast cancer stage i: t1 mic or t1a documented
g9705
Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented
g9706
Low (or very low) risk of recurrence, prostate cancer
g9707
Patient received hospice services any time during the measurement period
g9708
Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy
g9709
Hospice services used by patient any time during the measurement period
g9710
Patient was provided hospice services any time during the measurement period
g9711
Patients with a diagnosis or past history of total colectomy or colorectal cancer
g9712
Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis
g9713
Patients who use hospice services any time during the measurement period
g9714
Patient is using hospice services any time during the measurement period
g9715
Patients who use hospice services any time during the measurement period
g9716
Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
g9717
Documentation stating the patient has had a diagnosis of depression or has had a diagnosis of bipolar disorder
g9718
Hospice services for patient provided any time during the measurement period
g9719
Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
g9720
Hospice services for patient occurred any time during the measurement period
g9721
Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
g9722
Documented history of renal failure or baseline serum creatinine >= 4.0 mg/dl; renal transplant recipients are not considered to have preoperative renal failure, unless, since transplantation the cr has been or is 4.0 or higher
g9723
Hospice services for patient received any time during the measurement period
g9724
Patients who had documentation of use of anticoagulant medications overlapping the measurement year
g9725
Patients who use hospice services any time during the measurement period
g9726
Patient refused to participate
g9727
Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
g9728
Patient refused to participate
g9729
Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
g9730
Patient refused to participate
g9731
Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
g9732
Patient refused to participate
g9733
Patient unable to complete the low back fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
g9734
Patient refused to participate
g9735
Patient unable to complete the shoulder fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
g9736
Patient refused to participate
g9737
Patient unable to complete the elbow/wrist/hand fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
g9738
Patient refused to participate
g9739
Patient unable to complete the general orthopedic fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
g9740
Hospice services given to patient any time during the measurement period
g9741
Patients who use hospice services any time during the measurement period
g9742
Psychiatric symptoms assessed
g9743
Psychiatric symptoms not assessed, reason not otherwise specified
g9744
Patient not eligible due to active diagnosis of hypertension
g9745
Documented reason for not screening or recommending a follow-up for high blood pressure
g9746
Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
g9747
Patient is undergoing palliative dialysis with a catheter
g9748
Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
g9749
Patient is undergoing palliative dialysis with a catheter
g9750
Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
g9751
Patient died at any time during the 24-month measurement period
g9752
Emergency surgery
g9753
Documentation of medical reason for not conducting a search for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of the essence)
g9754
A finding of an incidental pulmonary nodule
g9755
Documentation of medical reason(s) for not including a recommended interval and modality for follow-up or for no follow-up, and source of recommendations (e.g., patients with unexplained fever, immunocompromised patients who are at risk for infection)
g9756
Surgical procedures that included the use of silicone oil
g9757
Surgical procedures that included the use of silicone oil
g9758
Patient in hospice at any time during the measurement period
g9759
History of preoperative posterior capsule rupture
g9760
Patients who use hospice services any time during the measurement period
g9761
Patients who use hospice services any time during the measurement period
g9762
Patient had at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
g9763
Patient did not have at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
g9764
Patient has been treated with a systemic medication for psoriasis vulgaris
g9765
Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
g9766
Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment
g9767
Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment
g9768
Patients who utilize hospice services any time during the measurement period
g9769
Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months
g9770
Peripheral nerve block (pnb)
g9771
At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time
g9772
Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.)
g9773
At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time, reason not given
g9774
Patients who have had a hysterectomy
g9775
Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
g9776
Documentation of medical reason for not receiving at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)
g9777
Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
g9778
Patients who have a diagnosis of pregnancy at any time during the measurement period
g9779
Patients who are breastfeeding at any time during the measurement period
g9780
Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period
g9781
Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, and patients with end stage renal disease [esrd])
g9782
History of or active diagnosis of familial hypercholesterolemia
g9783
Documentation of patients with diabetes who have a most recent fasting or direct ldl- c laboratory test result < 70 mg/dl and are not taking statin therapy
g9784
Pathologists/dermatopathologists providing a second opinion on a biopsy
g9785
Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
g9786
Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) was not sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
g9787
Patient alive as of the last day of the measurement year
g9788
Most recent bp is less than or equal to 140/90 mm hg
g9789
Blood pressure recorded during inpatient stays, emergency room visits, urgent care visits, and patient self-reported bp's (home and health fair bp results)
g9790
Most recent bp is greater than 140/90 mm hg, or blood pressure not documented
g9791
Most recent tobacco status is tobacco free
g9792
Most recent tobacco status is not tobacco free
g9793
Patient is currently on a daily aspirin or other antiplatelet
g9794
Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)
g9795
Patient is not currently on a daily aspirin or other antiplatelet
g9796
Patient is currently on a statin therapy
g9797
Patient is not on a statin therapy
g9798
Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period
g9799
Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure period
g9800
Patients who are identified as having an intolerance or allergy to beta-blocker therapy
g9801
Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis
g9802
Patients who use hospice services any time during the measurement period
g9803
Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
g9804
Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
g9805
Patients who use hospice services any time during the measurement period
g9806
Patients who received cervical cytology or an hpv test
g9807
Patients who did not receive cervical cytology or an hpv test
g9808
Any patients who had no asthma controller medications dispensed during the measurement year
g9809
Patients who use hospice services any time during the measurement period
g9810
Patient achieved a pdc of at least 75% for their asthma controller medication
g9811
Patient did not achieve a pdc of at least 75% for their asthma controller medication
g9812
Patient died including all deaths occurring during the hospitalization in which the operation was performed, even if after 30 days, and those deaths occurring after discharge from the hospital, but within 30 days of the procedure
g9813
Patient did not die within 30 days of the procedure or during the index hospitalization
g9814
Death occurring during the index acute care hospitalization
g9815
Death did not occur during the index acute care hospitalization
g9816
Death occurring after discharge from the hospital but within 30 days post procedure
g9817
Death did not occur after discharge from the hospital within 30 days post procedure
g9818
Documentation of sexual activity
g9819
Patients who use hospice services any time during the measurement period
g9820
Documentation of a chlamydia screening test with proper follow-up
g9821
No documentation of a chlamydia screening test with proper follow-up
g9822
Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date)
g9823
Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
g9824
Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
g9825
Her-2/neu negative or undocumented/unknown
g9826
Patient transferred to practice after initiation of chemotherapy
g9827
Her2-targeted therapies not administered during the initial course of treatment
g9828
Her2-targeted therapies administered during the initial course of treatment
g9829
Breast adjuvant chemotherapy administered
g9830
Her-2/neu positive
g9831
Ajcc stage at breast cancer diagnosis = ii or iii
g9832
Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis does not equal = t1, t1a, t1b
g9833
Patient transfer to practice after initiation of chemotherapy
g9834
Patient has metastatic disease at diagnosis
g9835
Trastuzumab administered within 12 months of diagnosis
g9836
Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)
g9837
Trastuzumab not administered within 12 months of diagnosis
g9838
Patient has metastatic disease at diagnosis
g9839
Anti-egfr monoclonal antibody therapy
g9840
Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab
g9841
Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab
g9842
Patient has metastatic disease at diagnosis
g9843
Ras (kras or nras) gene mutation
g9844
Patient did not receive anti-egfr monoclonal antibody therapy
g9845
Patient received anti-egfr monoclonal antibody therapy
g9846
Patients who died from cancer
g9847
Patient received chemotherapy in the last 14 days of life
g9848
Patient did not receive chemotherapy in the last 14 days of life
g9849
Patients who died from cancer
g9850
Patient had more than one emergency department visit in the last 30 days of life
g9851
Patient had one or less emergency department visits in the last 30 days of life
g9852
Patients who died from cancer
g9853
Patient admitted to the icu in the last 30 days of life
g9854
Patient was not admitted to the icu in the last 30 days of life
g9855
Patients who died from cancer
g9856
Patient was not admitted to hospice
g9857
Patient admitted to hospice
g9858
Patient enrolled in hospice
g9859
Patients who died from cancer
g9860
Patient spent less than three days in hospice care
g9861
Patient spent greater than or equal to three days in hospice care
g9862
Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons)
g9868
Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes
g9869
Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes
g9870
Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes
g9873
First medicare diabetes prevention program (mdpp) core session was attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
g9874
Four total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
g9875
Nine total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
g9876
Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9
g9877
Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12
g9878
Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions.the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9
g9879
Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12
g9880
The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight in months 1-12 of the mdpp services period under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 5% weight loss from baseline as measured by an in-person weight measurement at a core session or core maintenance session
g9881
The mdpp beneficiary achieved at least 9% weight loss (wl) from his/her baseline weight in months 1-24 under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session
g9882
Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 13-15 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 13-15
g9883
Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 16-18 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 16-18
g9884
Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 19-21 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 19-21
g9885
Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 22-24 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24
g9890
Bridge payment: a one-time payment for the first medicare diabetes prevention program (mdpp) core session, core maintenance session, or ongoing maintenance session furnished by an mdpp supplier to an mdpp beneficiary during months 1-24 of the mdpp expanded model (em) who has previously received mdpp services from a different mdpp supplier under the mdpp expanded model. a supplier may only receive one bridge payment per mdpp beneficiary
g9891
Mdpp session reported as a line-item on a claim for a payable mdpp expanded model (em) hcpcs code for a session furnished by the billing supplier under the mdpp expanded model and counting toward achievement of the attendance performance goal for the payable mdpp expanded model hcpcs code (this code is for reporting purposes only)
g9892
Documentation of patient reason(s) for not performing a dilated macular examination
g9893
Dilated macular exam was not performed, reason not otherwise specified
g9894
Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate
g9895
Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy)
g9896
Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate
g9897
Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given
g9898
Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
g9899
Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
g9900
Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
g9901
Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
g9902
Patient screened for tobacco use and identified as a tobacco user
g9903
Patient screened for tobacco use and identified as a tobacco non-user
g9904
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
g9905
Patient not screened for tobacco use, reason not given
g9906
Patient identified as a tobacco user received tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling and/or pharmacotherapy)
g9907
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)
g9908
Patient identified as tobacco user did not receive tobacco cessation intervention on the date of the encounter or within the previous 12 months (counseling and/or pharmacotherapy), reason not given
g9909
Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)
g9910
Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
g9911
Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy
g9912
Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy
g9913
Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not given
g9914
Patient receiving an anti-tnf agent
g9915
No record of hbv results documented
g9916
Functional status performed once in the last 12 months
g9917
Documentation of advanced stage dementia and caregiver knowledge is limited
g9918
Functional status not performed, reason not otherwise specified
g9919
Screening performed and positive and provision of recommendations
g9920
Screening performed and negative
g9921
No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified
g9922
Safety concerns screen provided and if positive then documented mitigation recommendations
g9923
Safety concerns screen provided and negative
g9924
Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason)
g9925
Safety concerns screening not provided, reason not otherwise specified
g9926
Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources
g9927
Documentation of system reason(s) for not prescribing an fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment
g9928
Fda-approved anticoagulant not prescribed, reason not given
g9929
Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
g9930
Patients who are receiving comfort care only
g9931
Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women
g9932
Documentation of patient reason(s) for not having records of negative or managed positive tb screen (e.g., patient does not return for mantoux (ppd) skin test evaluation)
g9933
Adenoma(s) or colorectal cancer detected during screening colonoscopy
g9934
Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
g9935
Adenoma(s) or colorectal cancer not detected during screening colonoscopy
g9936
Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus
g9937
Diagnostic colonoscopy
g9938
Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period
g9939
Pathologists/dermatopathologists is the same clinician who performed the biopsy
g9940
Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year)
g9941
Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively
g9942
Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
g9943
Back pain was not measured by the visual analog scale (vas) within three months preoperatively and at three months ( 6 - 20 weeks) postoperatively
g9944
Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
g9945
Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
g9946
Back pain was not measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
g9947
Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively
g9948
Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
g9949
Leg pain was not measured by the visual analog scale (vas) at three months (6 - 20 weeks) postoperatively
g9954
Patient exhibits 2 or more risk factors for post-operative vomiting
g9955
Cases in which an inhalational anesthetic is used only for induction
g9956
Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
g9957
Documentation of medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)
g9958
Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
g9959
Systemic antimicrobials not prescribed
g9960
Documentation of medical reason(s) for prescribing systemic antimicrobials
g9961
Systemic antimicrobials prescribed
g9962
Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy
g9963
Embolization endpoints are not documented separately for each embolized vessel or ovarian artery angiography or embolization not performed in the presence of variant uterine artery anatomy
g9964
Patient received at least one well-child visit with a pcp during the performance period
g9965
Patient did not receive at least one well-child visit with a pcp during the performance period
g9966
Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
g9967
Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
g9968
Patient was referred to another provider or specialist during the performance period
g9969
Provider who referred the patient to another provider received a report from the provider to whom the patient was referred
g9970
Provider who referred the patient to another provider did not receive a report from the provider to whom the patient was referred
g9974
Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity
g9975
Documentation of medical reason(s) for not performing a dilated macular examination
g9978
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9979
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9980
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9981
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9982
Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9983
Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9984
Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9985
Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9986
Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
g9987
Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a bpci advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code
g9988
Palliative care services provided to patient any time during the measurement period
g9989
Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
g9990
Pneumococcal vaccine was not administered on or after patient's 60th birthday and before the end of the measurement period, reason not otherwise specified
g9991
Pneumococcal vaccine administered on or after patient's 60th birthday and before the end of the measurement period
g9992
Palliative care services used by patient any time during the measurement period
g9993
Patient was provided pallative care services any time during the measurement period
g9994
Patient is using palliative care services any time during the measurement period
g9995
Patients who use palliative care services any time during the measurement period
g9996
Documentation stating the patient has received or is currently receiving palliative or hospice care
g9997
Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
g9998
Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, last colonoscopy found greater than 10 adenomas, or patient at high risk for colon cancer [crohn's disease, ulcerative colitis, lower gastrointestinal bleeding, personal or family history of colon cancer, hereditary colorectal cancer syndromes])
g9999
Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, previous colonoscopy report was incomplete)
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