Medical Billing Code Search
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9172 results found
| G9358 | Pp eval/edu not perf | Description: Post-partum screenings, evaluations and education not performed |
| G9359 | Neg mgd pos tb notact | Description: 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 doc of neg or man pos tb | Description: No documentation of negative or managed positive tb screen |
| G9361 | Doc rsn elect c-sec/induct | Description: 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 | Mac or pnb w/o genanes >60m | Description: 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 | Mac or pnb w/o genanes <60m | Description: 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 | Sinus caus bac inx | Description: Sinusitis caused by, or presumed to be caused by, bacterial infection |
| G9365 | 1high risk med ord | Description: One high-risk medication ordered |
| G9366 | 1high risk no ord | Description: One high-risk medication not ordered |
| G9367 | >= 2 same hi-rsk med ord | Description: At least two orders for high-risk medications from the same drug class |
| G9368 | >= 2 same hi-rsk med not ord | Description: At least two orders for high-risk medications from the same drug class not ordered |
| G9369 | Fill 2 rx antipsych | Description: Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater |
| G9370 | Not fill 2 rx antipsych | Description: 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 | Contd ret attach at 6mth f/u | Description: Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery |
| G9377 | No ret attach after 6mt | Description: Patient did not have the retina attached after 6 months following only one surgery |
| G9378 | Contd ret attach f/u vis | Description: Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) |
| G9379 | No acheive flat ret 6mth | Description: Patient did not achieve flat retinas six months post surgery |
| G9380 | Off assis eol iss | Description: Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period |
| G9381 | Doc med reas no offer eol | Description: 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 | No off assis eol | Description: Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period |
| G9383 | Recd scrn hcv infec | Description: Patient received screening for hcv infection within the 12 month reporting period |
| G9384 | Doc med rsn no hcv scrn | Description: 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 | Doc pt reas not rec hcv srn | Description: Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons) |
| G9386 | Scrn hcv infec not recd | Description: Screening for hcv infection not received within the 12 month reporting period, reason not given |
| G9389 | Unpln rup post cap | Description: Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery |
| G9390 | No unpln rup post cap | Description: No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery |
| G9391 | Achv refrac +1d | Description: Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit |
| G9392 | Not achv refrac +1d | Description: Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit |
| G9393 | Ini phq9 >9 remiss <5 | Description: 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 | Dx bipol, death, nhres, hosp | Description: 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 | Ini phq9 >9 no remiss >=5 | Description: 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 | Ini phq9 >9 not assess | Description: Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days) |
| G9399 | Doc disc tx choices | Description: 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 | Doc reas no disc tx opt | Description: 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 disc tx choices | Description: 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 | Recd f/u w/in 30d disch | Description: Patient received follow-up within 30 days after discharge |
| G9403 | Doc reas no 30 day f/u | Description: 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 | No 30 day f/u | Description: Patient did not receive follow-up within 30 days after discharge |
| G9405 | Recd f/u w/in 7d dc | Description: Patient received follow-up within 7 days after discharge |
| G9406 | Doc reas no 7d f/u | Description: 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 | No 7d f/u | Description: Patient did not receive follow-up within 7 days after discharge |
| G9408 | Card tamp w/in 30d | Description: Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days |
| G9409 | No card tamp e/in 30d | Description: Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days |
| G9410 | Admit w/in 180d req remov | Description: Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
| G9411 | No admit w/in 180d req remov | Description: Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
| G9412 | Admit w/in 180d req surg rev | Description: Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
| G9413 | No admit req surg rev | Description: Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
| G9416 | Pt 1 tdap betw 10-13 yrs | Description: Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays |
| G9417 | Pt not 1 tdap betw 10-13 yrs | Description: Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays |
| G9418 | Lungcx bx rpt docs class | Description: Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation |
| G9419 | Med reas not incl histo type | Description: 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 | Spec site no lung | Description: Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer |
| G9421 | Lung cx bx rpt no doc class | Description: 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 | Rpt doc class histo type | Description: 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 | Med reas rpt no histo type | Description: 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 | Site no lung or lung cx | Description: Specimen site other than anatomic location of lung, or classified as nsclc-nos |
| G9425 | Spec rpt no doc class histo | Description: 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 | Impr med time edarr pain med | Description: Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients |
| G9427 | No impro med time pain med | Description: Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients |
| G9428 | Patho rpt incl pt ctg | Description: 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 | Doc med rsn no pt cat | Description: 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 | Spec site no cutaneous | Description: Specimen site other than anatomic cutaneous location |
| G9431 | Patho rpt no pt ctg | Description: 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 | Asth controlled | Description: Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented |
| G9433 | Death, nhres, hospice | Description: Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period |
| G9434 | Asth not controlled | Description: 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 | Asp presc disch | Description: Aspirin prescribed at discharge |
| G9436 | Asp not presc doc reas | Description: Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) |
| G9437 | Asp not presc disch | Description: Aspirin not prescribed at discharge |
| G9438 | P2y inhib presc | Description: P2y inhibitor prescribed at discharge |
| G9439 | P2y inhib not presc doc reas | Description: P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) |
| G9440 | P2y inhib not presc | Description: P2y inhibitor not prescribed at discharge |
| G9441 | Statin presc disch | Description: Statin prescribed at discharge |
| G9442 | Statin not presc doc reas | Description: Statin not prescribed for documented reasons (e.g., allergy, medical intolerance) |
| G9443 | Statin not presc disch | Description: Statin not prescribed at discharge |
| G9448 | Born 1945-1965 | Description: Patients who were born in the years 1945 to 1965 |
| G9449 | Hx bld transf b/f 1992 | Description: History of receiving blood transfusions prior to 1992 |
| G9450 | Hx injec drug use | Description: History of injection drug use |
| G9451 | 1x scrn hcv infect | Description: Patient received one-time screening for hcv infection |
| G9452 | Doc med reas no hcv test | Description: Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy |
| G9453 | Pt reas no hcv infect | Description: Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons) |
| G9454 | No scr hcv inf 12 mth rp | Description: 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 | Abd imag w/us, ct or mri | Description: Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc |
| G9456 | Doc med pt reas no hcc scrn | Description: 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 | Pt no abd img no doc rsn | Description: Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period |
| G9458 | Tob user recd cess interv | Description: 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 | Tob non-user | Description: Currently a tobacco non-user |
| G9460 | No tob assess or cess inter | Description: Tobacco assessment or tobacco cessation intervention not performed, reason not given |
| G9463 | Sinusitis intent | Description: I intend to report the sinusitis measures group |
| G9464 | Sinusitis comp | Description: All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient |
| G9465 | Aoe intent | Description: I intend to report the acute otitis externa (aoe) measures group |
| G9466 | Aoe comp | Description: All quality actions for the applicable measures in the aoe measures group have been performed for this patient |
| G9467 | Recd cortico >=10mg/day >60d | Description: 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 | No recd cortico>=10mg/d >60d | Description: 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 | Rec cortico>90d or 1rx 900mg | Description: 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 | No rec cortico>60d 1rx 600mg | Description: 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 | W/in 2yr dxa not order | Description: Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented |
| G9472 | No dxa no med hx no rv sx | Description: 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 | Chap services at hospice | Description: Services performed by chaplain in the hospice setting, each 15 minutes |
| G9474 | Diet counsel at hospice | Description: Services performed by dietary counselor in the hospice setting, each 15 minutes |
| G9475 | Other counselor at hospice | Description: Services performed by other counselor in the hospice setting, each 15 minutes |
| G9476 | Volun service at hospice | Description: Services performed by volunteer in the hospice setting, each 15 minutes |
| G9477 | Care coord at hospice | Description: Services performed by care coordinator in the hospice setting, each 15 minutes |
| G9478 | Othe therapist at hospice | Description: Services performed by other qualified therapist in the hospice setting, each 15 minutes |
| G9479 | Pharmacist at hospice | Description: Services performed by qualified pharmacist in the hospice setting, each 15 minutes |
| G9480 | Admission to mccm | Description: Admission to medicare care choice model program (mccm) |
| G9481 | Remote e/m new pt 10mins | Description: 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 e/m new pt 20mins | Description: 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 e/m new pt 30mins | Description: 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 e/m new pt 45mins | Description: 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 e/m new pt 60mins | Description: 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 e/m est. pt 10mins | Description: 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 e/m est. pt 15mins | Description: 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 e/m est. pt 25mins | Description: 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 e/m est. pt 40mins | Description: 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 | Cmmi mod home visit | Description: 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 | Doc rsn no adeno/neopl detec | Description: 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 | Rec inst no smoke day surg | Description: Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery |
| G9498 | Abx reg prescribed | Description: Antibiotic regimen prescribed |
| G9499 | No start/rec antvir tx hep c | Description: Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period |
| G9500 | Rad expos ind/exp tm doc | Description: Radiation exposure indices documented in final report for procedure using fluoroscopy |
| G9501 | Rad expos ind/exp tm no doc | Description: Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given |
| G9502 | Med reas no perf foot exam | Description: 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 | Pt tk tams hcl | Description: Patient taking tamsulosin hydrochloride |
| G9504 | Doc rsn hep b stat not asses | Description: 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 | Abx pres w/in 10 dys of symp | Description: Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason |
| G9506 | Bio imm resp mod presc | Description: Biologic immune response modifier prescribed |
| G9507 | Doc reas on statin or contra | Description: 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 | Doc pt not on statin | Description: Documentation that the patient is not on a statin medication |
| G9509 | Adit mdd dys rem 12 mnths | Description: 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 | Remis12m not phq-9 score <5 | Description: 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 | Idx evt dte phq>9 doc 12 mo | Description: Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period |
| G9512 | Indiv pdc > 0.8 | Description: Individual had a pdc of 0.8 or greater |
| G9513 | Indiv pdc not > 0.8 | Description: Individual did not have a pdc of 0.8 or greater |
| G9514 | Req ret or w/in 90d of surg | Description: Patient required a return to the operating room within 90 days of surgery |
| G9515 | No reas, no ret or w/in 90d | Description: Patient did not require a return to the operating room within 90 days of surgery |
| G9516 | Impr vis acuit w/in 90d | Description: Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery |
| G9517 | No impr vis acuit w/in 90d | Description: Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given |
| G9518 | Doc active inj drug use | Description: Documentation of active injection drug use |
| G9519 | Final ref +/- 1.0 w/in 90d | Description: Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery |
| G9520 | Refract not +/- 1.0 w/in 90d | Description: Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery |
| G9521 | Er and ip hosp <2 in 12 mos | Description: Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months |
| G9522 | Er/ip hosp =/>2 in 12 mos | Description: 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 | D/c hemo or perit dialysis | Description: Patient discontinued from hemodialysis or peritoneal dialysis |
| G9524 | Refer to hospice | Description: Patient was referred to hospice care |
| G9525 | Doc pt reas no hospice refer | Description: Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons) |
| G9526 | No reason, no refer hospice | Description: Patient was not referred to hospice care, reason not given |
| G9529 | Minor blunt trauma w/head ct | Description: Patient with minor blunt head trauma had an appropriate indication(s) for a head ct |
| G9530 | Pt mbht hd ct ord ec prov | Description: Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider |
| G9531 | Pt doc | Description: 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 | Pt hd ct ord | Description: 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 | Indic for head ct not valid | Description: Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct |
| G9534 | Adv brain image not ordered | Description: Advanced brain imaging (cta, ct, mra or mri) was not ordered |
| G9535 | Normal neuro exam | Description: Patients with a normal neurological examination |
| G9536 | Doc med reas adv brain image | Description: 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 | Img hd clin trial | Description: Imaging needed as part of a clinical trial; or other clinician ordered the study |
| G9538 | Adv brain image ordered | Description: Advanced brain imaging (cta, ct, mra or mri) was ordered |
| G9539 | Intent pot remv time placemt | Description: Intent for potential removal at time of placement |
| G9540 | Pt alive 3 mos post proc | Description: Patient alive 3 months post procedure |
| G9541 | Filter rem 3 mon plmt | Description: Filter removed within 3 months of placement |
| G9542 | Doc reass appr remo filt 3ms | Description: Documented re-assessment for the appropriateness of filter removal within 3 months of placement |
| G9543 | Doc 2x re-assess filt remov | Description: 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 | No filt remov w/in 3mos plcm | Description: 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 | Cys ren les or adren | Description: 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 | No f/u rec image study | Description: Final reports for imaging studies stating no follow-up imaging is recommended |
| G9549 | Doc med rsn for f/u imag | Description: 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 | Imag rec | Description: 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 | Imag no les | Description: Final reports for imaging studies without an incidentally found lesion noted |
| G9552 | Inc thyr node <1.0 in rpt | Description: Incidental thyroid nodule < 1.0 cm noted in report |
| G9553 | Prior thyroid dise dx | Description: Prior thyroid disease diagnosis |
| G9554 | Ct/cta/mri/a chst foll rec | Description: Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended |
| G9555 | Doc med rsn for follup image | Description: 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 | Ct/cta/mri/a no follup imag | Description: Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended |
| G9557 | Ct/cta/mri/a no thyr <1.0cm | Description: 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 | Tx beta-lactam abx therapy | Description: Patient treated with a beta-lactam antibiotic as definitive therapy |
| G9559 | Doc med reas no abx therapy | Description: Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics) |
| G9560 | No beta-lactam abx ther, rng | Description: Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given |
| G9561 | Presc opiates >6 wks | Description: Patients prescribed opiates for longer than six weeks |
| G9562 | Foll-up eval q3mo opiod tx | Description: Patients who had a follow-up evaluation conducted at least every three months during opioid therapy |
| G9563 | No f/u eval q3mo opiod tx | Description: Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy |
| G9572 | Phq-scr >9 doc in 12m time | Description: Index date phq-score greater than 9 documented during the twelve month denominator identification period |
| G9573 | Adl pt md or dys rem 6 mon | Description: 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 | Adl pt md dys no rem 6 mon | Description: 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 | Presc opiates >6 wks | Description: Patients prescribed opiates for longer than six weeks |
| G9578 | Doc opioid tx 1x during ther | Description: Documentation of signed opioid treatment agreement at least once during opioid therapy |
| G9579 | No doc opioid tx 1x at ther | Description: No documentation of signed an opioid treatment agreement at least once during opioid therapy |
| G9580 | Door to punc time <2hrs | Description: Door to puncture time of 90 minutes or less |
| G9581 | Md doc, door to punc tm >2hr | Description: 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 punc time >2hr, nrg | Description: Door to puncture time of greater than 90 minutes, no reason given |
| G9583 | Presc opiates >6 wks | Description: Patients prescribed opiates for longer than six weeks |
| G9584 | Eval opioid use instr/pt int | Description: 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 | No eval opi use instr/intv | Description: 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 | Low pecarn ped head trauma | Description: Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules |
| G9594 | Pt mbht hd ct ord ec prov | Description: Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider |
| G9595 | Doc shnt/tum/coag | Description: Patient has documentation of ventricular shunt, brain tumor, or coagulopathy |
| G9596 | Ped pt hd ct ord | Description: 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 | No low pecarn ped head traum | Description: Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules |
| G9598 | Aor ane 5.5-5.9 cm max diam | Description: Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct |
| G9599 | Aor ane >=6.0 cm max diam | Description: Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct |
| G9600 | Symp aaa urgent repair | Description: Symptomatic aaas that required urgent/emergent (non-elective) repair |
| G9601 | Pt dchg home post op day 7 | Description: Patient discharge to home no later than post-operative day #7 |
| G9602 | Pt no dchg home postop day 7 | Description: Patient not discharged to home by post-operative day #7 |
| G9603 | Pt surv improv bsline tx | Description: Patient survey score improved from baseline following treatment |
| G9605 | Surv score no improv w/tx | Description: Patient survey score did not improve from baseline following treatment |
| G9606 | Intraop cyst eval trac inj | Description: Intraoperative cystoscopy performed to evaluate for lower tract injury |
| G9607 | Doc med rsn not perf cystosc | Description: 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 | Intraop cyst eval not done | Description: Intraoperative cystoscopy not performed to evaluate for lower tract injury |
| G9609 | Doc order anti-plat | Description: Documentation of an order for anti-platelet agents |
| G9610 | Doc md rsn no antipla | Description: Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents |
| G9611 | No doc order anti-plat rng | Description: Order for anti-platelet agents was not documented in the patient's record, reason not given |
| G9612 | Phodoc 2 mr cec lndmk | Description: Photodocumentation of two or more cecal landmarks to establish a complete examination |
| G9613 | Doc post surg anatomy | Description: Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.) |
| G9614 | Photodoc < 2 cec lndmk | Description: Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination |
| G9615 | Pre-op asst doc | Description: Preoperative assessment documented |
| G9616 | Doc rsn no preop assmt | Description: 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 | Pre-op asst not doc, rng | Description: Preoperative assessment not documented, reason not given |
| G9618 | Doc scr uter mal or us/samp | Description: Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind |
| G9619 | Doc rsn no scr uter malig | Description: Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy) |
| G9620 | No scr utr malig/us/samp rng | Description: 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 | Scr unheal etoh w/counsel | Description: Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling |
| G9622 | No unheal etoh user | Description: Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method |
| G9623 | Doc med rsn no scr etoh use | Description: Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons) |
| G9624 | Pt not scrn or no counseling | Description: 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 |
| G9625 | Pt bl srg 30 day pst srg | Description: Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery |
| G9626 | Med rsn no rpt bladder inj | Description: 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 a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury) |
| G9627 | Pt no bl srg 30 day pst srg | Description: Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery |
| G9628 | Pt bwli srg 30 day pst srg | Description: Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery |
| G9629 | Med rsn no rpt bowel inj | Description: 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 | Pt no bwli srg 30 day srg | Description: Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery |
| G9631 | Pt ui srg 30 day pst srg | Description: Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery |
| G9632 | Med rsn for no rpt uret inj | Description: 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 | Pt no ui srg 30 day pst srg | Description: Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery |
| G9634 | Qual life tool 2x same/impr | Description: Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved |
| G9635 | No doc rsn do qual life assm | Description: 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 | No life asst 2x same/decr | Description: Health-related quality of life not assessed with tool during at least two visits or quality of life score declined |
| G9637 | Doc >1 dose reduc tech | Description: 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 | No doc >1 dose reduc tech | Description: 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 | Amp no reqd in48h ieler proc | Description: Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure |
| G9640 | Doc plan hybrid/stage proc | Description: Documentation of planned hybrid or staged procedure |
| G9641 | Amp reqd w/in 48h ieler proc | Description: Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure |
| G9642 | Current smoker | Description: Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana) |
| G9643 | Elective surgery | Description: Elective surgery |
| G9644 | No smok b/4 anes day of surg | Description: Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure |
| G9645 | Had smoke b/4 anes day surg | Description: Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure |
| G9646 | Pt w/90d mrs 0-2 | Description: Patients with 90 day mrs score of 0 to 2 |
| G9647 | No mrs score in 90d followup | Description: Patients in whom mrs score could not be obtained at 90 day follow-up |
| G9648 | Pt w/90d mrs >2 | Description: Patients with 90 day mrs score greater than 2 |
| G9649 | Psor as doc spc bm | Description: 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 | Doc pt no ther chg or contra | Description: 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 | Psor as doc no spc bm | Description: 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 | Pt tx sys bio med psori 6mth | Description: Patient has been treated with a systemic or biologic medication for psoriasis for at least six months |
| G9653 | Pt no tx sys bio rx 6 mths | Description: Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months |
| G9654 | Mon anesth care | Description: Monitored anesthesia care (mac) |
| G9655 | Toc tool incl key elem | Description: A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used |
| G9656 | Pt trans from anest to pacu | Description: Patient transferred directly from anesthetizing location to pacu or other non-icu location |
| G9657 | Toc dur aneth to icu | Description: Transfer of care during an anesthetic or to the intensive care unit |
| G9658 | Toc tool incl elem not used | Description: A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used |
| G9659 | >=86y scr colo nomed rsn | Description: 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, familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits |
| G9660 | Doc med rsn colo pt >= 86y | Description: 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, familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits) |
| G9661 | Pt >= 86 w/ hi risk | Description: 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 | Prior dx/active clin ascvd | Description: Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure |
| G9663 | Fast/dir ldl >= 190 mg/dl | Description: Any ldl-c laboratory result >= 190 mg/dl |
| G9664 | Taking statin or rec'd order | Description: Patients who are currently statin therapy users or received an order (prescription) for statin therapy |
| G9665 | No statin/no order statin | Description: Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy |
| G9666 | Fas/dir ldl 70-189mg/dl mst | Description: 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 | Doc med rsn no stat tx/presc | Description: 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 | Intend rpt mult chr msr grp | Description: I intend to report the multiple chronic conditions measures group |
| G9670 | Qty act mcc mg perf | Description: All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient |
| G9671 | Intend rpt dia retin msr grp | Description: I intend to report the diabetic retinopathy measures group |
| G9672 | Qty act diab retin mg perf | Description: All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient |
| G9673 | Intend rpt card prev msr grp | Description: I intend to report the cardiovascular prevention measures group |
| G9674 | Pt w/clin ascvd dx | Description: Patients with clinical ascvd diagnosis |
| G9675 | Pt w/fast/dir lab ldl-c >190 | Description: Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl |
| G9676 | 40-75y w/type 1/2 w/ldl-c rs | Description: 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 | Qty act card prev mg perf | Description: All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient |
| G9678 | Oncology care model service | Description: 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 | Acute care pneumonia | Description: 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 | Acute care congestive heart | Description: 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 | Acute care chronic obstruct | Description: 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 | Acute care skin infection | Description: 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 | Acute fluid/electro disorder | Description: 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 | Acute care urinary tract inf | Description: 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 | Acute nursing facility care | Description: 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 | Nursing facility conference | Description: 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 anytime msmt per | Description: Hospice services provided to patient any time during the measurement period |
| G9688 | Pt w/hosp anytime msmt per | Description: Patients using hospice services any time during the measurement period |
| G9689 | Inpt elect carotid intervent | Description: Patient admitted for performance of elective carotid intervention |
| G9690 | Pt in hos | Description: Patient receiving hospice services any time during the measurement period |
| G9691 | Pt hosp dur msmt period | Description: Patient had hospice services any time during the measurement period |
| G9692 | Hosp recd by pt dur msmt per | Description: Hospice services received by patient any time during the measurement period |
| G9693 | Pt use hosp during msmt per | Description: Patient use of hospice services any time during the measurement period |
| G9694 | Hosp srv used pt in msmt per | Description: Hospice services utilized by patient any time during the measurement period |
| G9695 | Long act inhal bronchdil pre | Description: Long-acting inhaled bronchodilator prescribed |
| G9696 | Med rsn no presc bronchdil | Description: Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects) |
| G9697 | Pt rsn no presc bronchdil | Description: Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator |
| G9698 | Sys rsn no presc bronchdil | Description: Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance) |
| G9699 | Long inhal bronchdil no pres | Description: Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified |
| G9700 | Pt is w/hosp during msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9701 | Child anbx 30 prior dx estab | Description: Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established |
| G9702 | Pt use hosp during msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9703 | Anbx 30 prior to episode | Description: Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date |
| G9704 | Ajcc br ca stg i: t1 mic/t1a | Description: Ajcc breast cancer stage i: t1 mic or t1a documented |
| G9705 | Ajcc br ca stg ib | Description: Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented |
| G9706 | Low recur prost ca | Description: Low (or very low) risk of recurrence, prostate cancer |
| G9707 | Pt had hosp dur msmt per | Description: Patient received hospice services any time during the measurement period |
| G9708 | Bilat mast/hx bi /unilat mas | Description: 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 | Hosp srv used pt in msmt per | Description: Hospice services used by patient any time during the measurement period |
| G9710 | Pt prov hosp srv msmt per | Description: Patient was provided hospice services any time during the measurement period |
| G9711 | Pt hx tot col or colon ca | Description: Patients with a diagnosis or past history of total colectomy or colorectal cancer |
| G9712 | Doc med rsn presc anbx | Description: 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 | Pt use hosp during msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9714 | Pt is w/hosp during msmt per | Description: Patient is using hospice services any time during the measurement period |
| G9715 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9716 | Bmi doc onl fup not cmpltd | Description: Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason |
| G9717 | Doc pt dx bipol | Description: Documentation stating the patient has had a diagnosis of bipolar disorder |
| G9718 | Hospice anytime msmt per | Description: Hospice services for patient provided any time during the measurement period |
| G9719 | Pt not ambul/immob/wc | Description: 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 anytime msmt per | Description: Hospice services for patient occurred any time during the measurement period |
| G9721 | Pt not ambul/immob/wc | Description: 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 | Doc hx renal fail or cr+ >=4 | Description: 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 | Hosp recd by pt dur msmt per | Description: Hospice services for patient received any time during the measurement period |
| G9724 | Pt w/doc use anticoag mst yr | Description: Patients who had documentation of use of anticoagulant medications overlapping the measurement year |
| G9725 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9726 | Refused to participate | Description: Patient refused to participate |
| G9727 | Pt unable cmplt lepf prom | Description: 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 | Refused to participate | Description: Patient refused to participate |
| G9729 | Pt unbl cmplt lepf prom | Description: 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 | Refused to participate | Description: Patient refused to participate |
| G9731 | Pt unbl cmplt lepf prom | Description: 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 | Refused to participate | Description: Patient refused to participate |
| G9733 | Pt unbl cmplt lb fs prom | Description: 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 | Refused to participate | Description: Patient refused to participate |
| G9735 | Pt unbl cmplt shld fs prom | Description: 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 | Refused to participate | Description: Patient refused to participate |
| G9737 | Pt unbl cmplt ewh fs prom | Description: 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 | Refused to participate | Description: Patient refused to participate |
| G9739 | Pt unbl cmplt go fs prom | Description: 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 | Hosp srv to pt dur msmt per | Description: Hospice services given to patient any time during the measurement period |
| G9741 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9742 | Psych sympt assessed | Description: Psychiatric symptoms assessed |
| G9743 | Psych symp not assessed, rns | Description: Psychiatric symptoms not assessed, reason not otherwise specified |
| G9744 | Pt not eli d/t act dig htn | Description: Patient not eligible due to active diagnosis of hypertension |
| G9745 | Doc rsn no hbp scrn or f/u | Description: Documented reason for not screening or recommending a follow-up for high blood pressure |
| G9746 | Mit sten, valve or trans af | Description: 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 | Pall dialysis with catheter | Description: Patient is undergoing palliative dialysis with a catheter |
| G9748 | App transpl lvg kidney donor | Description: Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant |
| G9749 | Pall dialysis with catheter | Description: Patient is undergoing palliative dialysis with a catheter |
| G9750 | App transpl lvg kidney donor | Description: Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant |
| G9751 | Pt died w/in 24 mos rpt time | Description: Patient died at any time during the 24-month measurement period |
| G9752 | Urgent surgery | Description: Emergency surgery |
| G9753 | Doc no dicom, ct other fac | Description: 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 | Incid pulm nodule | Description: A finding of an incidental pulmonary nodule |
| G9755 | Doc med rsn no fllw up | Description: 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 | Surg proc w/silicone oil | Description: Surgical procedures that included the use of silicone oil |
| G9757 | Surg proc w/silicone oil | Description: Surgical procedures that included the use of silicone oil |
| G9758 | Pt in hos | Description: Patient in hospice at any time during the measurement period |
| G9759 | Hx preop post cap rup | Description: History of preoperative posterior capsule rupture |
| G9760 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9761 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9762 | Pt had >= 2-3 hpv vaccines | Description: 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 | Pt not have 2-3 hpv vaccines | Description: 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 | Pt treatd w/oral syst or bio | Description: Patient has been treated with a systemic medication for psoriasis vulgaris |
| G9765 | Doc pat declined therapy | Description: 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 | Cva stroke dx tx transf fac | Description: Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment |
| G9767 | Hosp new dx cva consid evst | Description: Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment |
| G9768 | Pt w/hosp anytime msmt per | Description: Patients who utilize hospice services any time during the measurement period |
| G9769 | Bn den 2yr/got ost med/ther | Description: Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months |
| G9770 | Perip nerve block | Description: Peripheral nerve block (pnb) |
| G9771 | Anes end, 1 temp >35.5(95.9) | Description: 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 15 minutes immediately after anesthesia end time |
| G9772 | Doc med rsn no temp >= 35.5 | Description: 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 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.) |
| G9773 | 1 bod temp >=35.5 | Description: 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 15 minutes immediately after anesthesia end time, reason not given |
| G9774 | Pt had hyst | Description: Patients who have had a hysterectomy |
| G9775 | Recd 2 anti-emet pre/intraop | Description: Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively |
| G9776 | Doc med rsn no proph antiem | Description: 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 | Pt no antiemet pre/intraop | Description: Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively |
| G9778 | Pts dx w/pregn | Description: Patients who have a diagnosis of pregnancy at any time during the measurement period |
| G9779 | Pts breastfeeding | Description: Patients who are breastfeeding at any time during the performance period |
| G9780 | Pts dx w/rhabdomyolysis | Description: Patients who have a diagnosis of rhabdomyolysis at any time during the performance period |
| G9781 | Doc rsn no statin | Description: 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, patients with end stage renal disease [esrd], or other medical reasons) |
| G9782 | Hx dx fam/pure hypercholes | Description: History of or active diagnosis of familial hypercholesterolemia |
| G9783 | Doc dx dm, fast <70, no stat | Description: 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 | Path/derm prov 2nd biop opin | Description: Pathologists/dermatopathologists providing a second opinion on a biopsy |
| G9785 | Path report sent | Description: 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 | Path report not sent | Description: 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 | Pt alive | Description: Patient alive as of the last day of the measurement year |
| G9789 | Record bp ip, er, urg/self | Description: Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits |
| G9791 | Most rct tob stat free | Description: Most recent tobacco status is tobacco free |
| G9792 | Most rct tob stat not free | Description: Most recent tobacco status is not tobacco free |
| G9793 | Pt on daily asa/antiplat | Description: Patient is currently on a daily aspirin or other antiplatelet |
| G9794 | Doc med rsn no daily aspirin | Description: 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 | Pt no daily asa/antiplat | Description: Patient is not currently on a daily aspirin or other antiplatelet |
| G9798 | D/c ami btw 7/1-6/30 meas pd | Description: Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period |
| G9799 | Med disp evt indic hx asth | Description: 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 | Pt id intol/alleg beta-block | Description: Patients who are identified as having an intolerance or allergy to beta-blocker therapy |
| G9801 | Nonacut transf from inpt | Description: Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis |
| G9802 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9803 | Pt presc 135 day trmt | Description: Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami |
| G9804 | Pt not presc 135 day trmt | Description: Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami |
| G9805 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9806 | Pt recd cerv cyto/hpv | Description: Patients who received cervical cytology or an hpv test |
| G9807 | Pt no recd cerv cyto/hpv | Description: Patients who did not receive cervical cytology or an hpv test |
| G9808 | Pt no asthm cont med mst per | Description: Any patients who had no asthma controller medications dispensed during the measurement year |
| G9809 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9810 | Pdc 75% w/asth cont med | Description: Patient achieved a pdc of at least 75% for their asthma controller medication |
| G9811 | No pdc 75% w/asth cont med | Description: Patient did not achieve a pdc of at least 75% for their asthma controller medication |
| G9812 | Pt died during inpt/30d aft | Description: 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 | Pt not died w/in 30d of proc | Description: Patient did not die within 30 days of the procedure or during the index hospitalization |
| G9814 | Death during index hosp | Description: Death occurring during the index acute care hospitalization |
| G9815 | Death not during index hosp | Description: Death did not occur during the index acute care hospitalization |
| G9816 | Death <30 day post discharge | Description: Death occurring after discharge from the hospital but within 30 days post procedure |
| G9817 | No death 30-days post-disch | Description: Death did not occur after discharge from the hospital within 30 days post procedure |
| G9818 | Doc sex activity | Description: Documentation of sexual activity |
| G9819 | Pt w/hosp anytime msmt per | Description: Patients who use hospice services any time during the measurement period |
| G9820 | Doc chlam scr test w/follow | Description: Documentation of a chlamydia screening test with proper follow-up |
| G9821 | No doc chlam scr ts w/follow | Description: No documentation of a chlamydia screening test with proper follow-up |
| G9822 | Endo abl proc yr prev ind dt | Description: Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date) |
| G9823 | Endo smpl/hyst bx res doc | Description: 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 | Endo smpl/hyst bx res no doc | Description: 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 neg,undoc/unkn | Description: Her-2/neu negative or undocumented/unknown |
| G9826 | Transf pract aft init chemo | Description: Patient transferred to practice after initiation of chemotherapy |
| G9827 | Her-2 targ ther no init tx | Description: Her2-targeted therapies not administered during the initial course of treatment |
| G9828 | Her-2 targ ther dur init tx | Description: Her2-targeted therapies administered during the initial course of treatment |
| G9829 | Breast adj chemo admin | Description: Breast adjuvant chemotherapy administered |
| G9830 | Her-2 pos | Description: Her-2/neu positive |
| G9831 | Ajcc stg brt ca dx ii or iii | Description: Ajcc stage at breast cancer diagnosis = ii or iii |
| G9833 | Transf pract aft init chemo | Description: Patient transfer to practice after initiation of chemotherapy |
| G9834 | Pt met dis at dx | Description: Patient has metastatic disease at diagnosis |
| G9835 | Trastuz given w/in 12 mos dx | Description: Trastuzumab administered within 12 months of diagnosis |
| G9836 | Rsn no trast given doc | Description: 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 | Trastuz not in 12 mos dx | Description: Trastuzumab not administered within 12 months of diagnosis |
| G9838 | Pt met dis at dx | Description: Patient has metastatic disease at diagnosis |
| G9839 | Anti-egfr mon anti ther | Description: Anti-egfr monoclonal antibody therapy |
| G9840 | Gene testing performed | Description: Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab |
| G9841 | Gene testing not performed | Description: Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab |
| G9842 | Pt met dis at dx | Description: Patient has metastatic disease at diagnosis |
| G9843 | Kras or nras gene mutation | Description: Ras (kras or nras) gene mutation |
| G9844 | Pt no recd anti-egfr ther | Description: Patient did not receive anti-egfr monoclonal antibody therapy |
| G9845 | Pt recd anti-egfr ther | Description: Patient received anti-egfr monoclonal antibody therapy |
| G9846 | Pt died from cancer | Description: Patients who died from cancer |
| G9847 | Pt recd chemo last 14d life | Description: Patient received systemic cancer-directed therapy in the last 14 days of life |
| G9848 | Pt no chemo last 14d life | Description: Patient did not receive systemic cancer-directed therapy in the last 14 days of life |
| G9849 | Pt died from cancer | Description: Patients who died from cancer |
| G9850 | 1/more ed last 30d life | Description: Patient had more than one emergency department visit in the last 30 days of life |
| G9851 | 1/no ed visit last 30d life | Description: Patient had one or less emergency department visits in the last 30 days of life |
| G9852 | Pt died from cancer | Description: Patients who died from cancer |
| G9853 | Icu stay last 30d life | Description: Patient admitted to the icu in the last 30 days of life |
| G9854 | No icu stay last 30d life | Description: Patient was not admitted to the icu in the last 30 days of life |
| G9855 | Pt died from cancer | Description: Patients who died from cancer |
| G9856 | Pt no hospice | Description: Patient was not admitted to hospice |
| G9857 | Pt admit hospice | Description: Patient admitted to hospice |
| G9858 | Pt enroll hospice | Description: Patient enrolled in hospice |
| G9859 | Pt died from cancer | Description: Patients who died from cancer |
| G9860 | Pt less 3d hospice | Description: Patient spent less than three days in hospice care |
| G9861 | Pt more than 3d hospice | Description: Patient spent greater than or equal to three days in hospice care |
| G9862 | Doc rsn no 10 yr follow | Description: 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 | Cmmi asyntelehealth <10min | Description: 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 | Cmmi asyntelehealth 10-20min | Description: 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 | Cmmi asyntelehealth >20min | Description: 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 | 1 em core session | Description: 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 | 4 em core sessions | Description: 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 | 9 em core sessions | Description: 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 | 2 em core ms mo 7-9 no wl | Description: 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 | 2 em core ms mo 10-12 no wl | Description: 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 | 2 em core ms mo 7-9 wl | Description: 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 | 2 em core ms mo 10-12 wl | Description: 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 | Em 5 percent wl | Description: 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 | Em 9 percent wl | Description: 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 | 2 em ongoing ms mo 13-15 wl | Description: 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 | 2 em ongoing ms mo 16-18 wl | Description: 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 | 2 em ongoing ms mo 19-21 wl | Description: 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 | 2 em ongoing ms mo 22-24 wl | Description: 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 |
| G9886 | In-person attendance g code | Description: Behavioral counseling for diabetes prevention, in-person, group, 60 minutes |
| G9887 | Distance learning attendance | Description: Behavioral counseling for diabetes prevention, distance learning, 60 minutes |
| G9888 | 5% wl maintnd from bsline wt | Description: Maintenance 5% wl from baseline weight in months 7-12 |
| G9890 | Em bridge payment | Description: 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 | Em session reporting | Description: 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 | Doc pt rsn no dil mac exam | Description: Documentation of patient reason(s) for not performing a dilated macular examination |
| G9893 | No mac exam | Description: Dilated macular exam was not performed, reason not otherwise specified |
| G9894 | Adr dep thrpy prescribed | Description: Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate |
| G9895 | Doc med rsn no adr dep thrpy | Description: 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 | Doc pt rsn no adr dep thrpy | Description: Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate |
| G9897 | Pt nt prsc adr dep thrpy rng | Description: Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given |
| G9898 | Pt 66+ snp or ltc pos > 90d | Description: 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 | Scrn mam perf rslts doc | Description: Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed |
| G9900 | Scrn mam perf rslts not doc | Description: Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified |
| G9901 | Pt 66+ snp or ltc pos > 90d | Description: 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 | Pt scrn tbco and id as user | Description: Patient screened for tobacco use and identified as a tobacco user |
| G9903 | Pt scrn tbco id as non user | Description: Patient screened for tobacco use and identified as a tobacco non-user |
| G9904 | Doc med rsn no tbco scrn | Description: Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) |
| G9905 | No pt tbco scrn rng | Description: Patient not screened for tobacco use |
| G9906 | Pt recv tbco cess interv | Description: Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) |
| G9907 | Doc med rsn no tbco interv | Description: 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 | No pt tbco cess interv rng | Description: Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) |
| G9909 | Doc med rsn no tbco interv | Description: 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 | Pt 66+ snp or ltc pos > 90d | Description: 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 | Node neg pre/post syst ther | Description: Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy |
| G9912 | Hbv status assesed and int | Description: Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy |
| G9913 | No hbv status assesd and int | Description: Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified |
| G9914 | Pt initiated anti-tnf agent | Description: Patient initiated an anti-tnf agent |
| G9915 | No documntd hbv results rcd | Description: No record of hbv results documented |