Medical Billing Code Search
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8892 results found
| G8912 | Pt doc with wrong event | Description: Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event |
| G8913 | Pt doc no wrong event | Description: Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event |
| G8914 | Pt trans to hosp post d/c | Description: Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc |
| G8915 | Pt not trans to hosp at d/c | Description: Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc |
| G8916 | Pt w iv ab given on time | Description: Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time |
| G8917 | Pt w iv ab not given on time | Description: Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time |
| G8918 | Pt w/o preop order iv ab pro | Description: Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis |
| G8924 | Spir res doc fev1/fvc<70% | Description: Spirometry results documented (fev1/fvc < 70%) |
| G8935 | Rx ace or arb therapy | Description: Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy |
| G8936 | Pt not eligible ace/arb | Description: Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons) |
| G8937 | No rx ace/arb therapy | Description: Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given |
| G8942 | Doc fcn/care plan w/30 days | Description: Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment |
| G8944 | Ajcc mel cnr stg 0 - iic | Description: Ajcc melanoma cancer stage 0 through iic melanoma |
| G8946 | Mibm but no dx of breast ca | Description: Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells) |
| G8950 | Pre-htn or htn doc, f/u indc | Description: Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented |
| G8952 | Pre-htn/htn, no f/u, not gvn | Description: Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given |
| G8955 | Most recent assess vol mgmt | Description: Most recent assessment of adequacy of volume management documented |
| G8956 | Pt rcv hedia outpt dyls fac | Description: Patient receiving maintenance hemodialysis in an outpatient dialysis facility |
| G8958 | Assess vol mgmt not doc | Description: Assessment of adequacy of volume management not documented, reason not given |
| G8961 | Csit lowrisk surg pts preop | Description: Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery |
| G8962 | Csit on pt any reas 30 days | Description: Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery |
| G8967 | Warf or other fda drug presc | Description: Fda approved oral anticoagulant is prescribed |
| G8968 | Doc med not presb | Description: Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation or patient being currently enrolled in a clinical trial related to af/atrial flutter treatment) |
| G8969 | Doc pt rsn no presc warf/fda | Description: Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation) |
| G8970 | No rsk fac or 1 mod risk te | Description: No risk factors or one moderate risk factor for thromboembolism |
| G9001 | Mccd, initial rate | Description: Coordinated care fee, initial rate |
| G9002 | Mccd,maintenance rate | Description: Coordinated care fee, maintenance rate |
| G9003 | Mccd, risk adj hi, initial | Description: Coordinated care fee, risk adjusted high, initial |
| G9004 | Mccd, risk adj lo, initial | Description: Coordinated care fee, risk adjusted low, initial |
| G9005 | Mccd, risk adj, maintenance | Description: Coordinated care fee, risk adjusted maintenance |
| G9006 | Mccd, home monitoring | Description: Coordinated care fee, home monitoring |
| G9007 | Mccd, sch team conf | Description: Coordinated care fee, scheduled team conference |
| G9008 | Mccd,phys coor-care ovrsght | Description: Coordinated care fee, physician coordinated care oversight services |
| G9009 | Mccd, risk adj, level 3 | Description: Coordinated care fee, risk adjusted maintenance, level 3 |
| G9010 | Mccd, risk adj, level 4 | Description: Coordinated care fee, risk adjusted maintenance, level 4 |
| G9011 | Mccd, risk adj, level 5 | Description: Coordinated care fee, risk adjusted maintenance, level 5 |
| G9012 | Other specified case mgmt | Description: Other specified case management service not elsewhere classified |
| G9013 | Esrd demo bundle level i | Description: Esrd demo basic bundle level i |
| G9014 | Esrd demo bundle-level ii | Description: Esrd demo expanded bundle including venous access and related services |
| G9016 | Demo-smoking cessation coun | Description: Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only] |
| G9050 | Oncology work-up evaluation | Description: Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project) |
| G9051 | Oncology tx decision-mgmt | Description: Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project) |
| G9052 | Onc surveillance for disease | Description: Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project) |
| G9053 | Onc expectant management pt | Description: Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project) |
| G9054 | Onc supervision palliative | Description: Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project) |
| G9055 | Onc visit unspecified nos | Description: Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project) |
| G9056 | Onc prac mgmt adheres guide | Description: Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project) |
| G9057 | Onc pract mgmt differs trial | Description: Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project) |
| G9058 | Onc prac mgmt disagree w/gui | Description: Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project) |
| G9059 | Onc prac mgmt pt opt alterna | Description: Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project) |
| G9060 | Onc prac mgmt dif pt comorb | Description: Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project) |
| G9061 | Onc prac cond noadd by guide | Description: Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project) |
| G9062 | Onc prac guide differs nos | Description: Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project) |
| G9063 | Onc dx nsclc stgi no progres | Description: Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9064 | Onc dx nsclc stg2 no progres | Description: Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9065 | Onc dx nsclc stg3a no progre | Description: Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9066 | Onc dx nsclc stg3b-4 metasta | Description: Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9067 | Onc dx nsclc dx unknown nos | Description: Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9068 | Onc dx sclc/nsclc limited | Description: Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9069 | Onc dx sclc/nsclc ext at dx | Description: Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9070 | Onc dx sclc/nsclc ext unknwn | Description: Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9071 | Onc dx brst stg1-2b hr,nopro | Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9072 | Onc dx brst stg1-2 noprogres | Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9073 | Onc dx brst stg3-hr, no pro | Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9074 | Onc dx brst stg3-noprogress | Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9075 | Onc dx brst metastic/ recur | Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9077 | Onc dx prostate t1no progres | Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9078 | Onc dx prostate t2no progres | Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9079 | Onc dx prostate t3b-t4noprog | Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9080 | Onc dx prostate w/rise psa | Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project) |
| G9083 | Onc dx prostate unknwn nos | Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9084 | Onc dx colon t1-3,n1-2,no pr | Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9085 | Onc dx colon t4, n0 w/o prog | Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9086 | Onc dx colon t1-4 no dx prog | Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9087 | Onc dx colon metas evid dx | Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project) |
| G9088 | Onc dx colon metas noevid dx | Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project) |
| G9089 | Onc dx colon extent unknown | Description: Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9090 | Onc dx rectal t1-2 no progr | Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9091 | Onc dx rectal t3 n0 no prog | Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9092 | Onc dx rectal t1-3,n1-2noprg | Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project) |
| G9093 | Onc dx rectal t4,n,m0 no prg | Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9094 | Onc dx rectal m1 w/mets prog | Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9095 | Onc dx rectal extent unknwn | Description: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9096 | Onc dx esophag t1-t3 noprog | Description: Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9097 | Onc dx esophageal t4 no prog | Description: Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9098 | Onc dx esophageal mets recur | Description: Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9099 | Onc dx esophageal unknown | Description: Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9100 | Onc dx gastric no recurrence | Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project) |
| G9101 | Onc dx gastric p r1-r2noprog | Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) |
| G9102 | Onc dx gastric unresectable | Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) |
| G9103 | Onc dx gastric recurrent | Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9104 | Onc dx gastric unknown nos | Description: Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9105 | Onc dx pancreatc p r0 res no | Description: Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9106 | Onc dx pancreatc p r1/r2 no | Description: Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) |
| G9107 | Onc dx pancreatic unresectab | Description: Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9108 | Onc dx pancreatic unknwn nos | Description: Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9109 | Onc dx head/neck t1-t2no prg | Description: Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9110 | Onc dx head/neck t3-4 noprog | Description: Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9111 | Onc dx head/neck m1 mets rec | Description: Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
| G9112 | Onc dx head/neck ext unknown | Description: Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9113 | Onc dx ovarian stg1a-b no pr | Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9114 | Onc dx ovarian stg1a-b or 2 | Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9115 | Onc dx ovarian stg3/4 noprog | Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
| G9116 | Onc dx ovarian recurrence | Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project) |
| G9117 | Onc dx ovarian unknown nos | Description: Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9123 | Onc dx cml chronic phase | Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
| G9124 | Onc dx cml acceler phase | Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
| G9125 | Onc dx cml blast phase | Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
| G9126 | Onc dx cml remission | Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
| G9128 | Onc dx multi myeloma stage i | Description: Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project) |
| G9129 | Onc dx mult myeloma stg2 hig | Description: Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project) |
| G9130 | Onc dx multi myeloma unknown | Description: Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9131 | Onc dx brst unknown nos | Description: Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
| G9132 | Onc dx prostate mets no cast | Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project) |
| G9133 | Onc dx prostate clinical met | Description: Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project) |
| G9134 | Onc nhlstg 1-2 no relap no | Description: Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project) |
| G9135 | Onc dx nhl stg 3-4 not relap | Description: Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project) |
| G9136 | Onc dx nhl trans to lg bcell | Description: Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project) |
| G9137 | Onc dx nhl relapse/refractor | Description: Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project) |
| G9138 | Onc dx nhl stg unknown | Description: Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project) |
| G9139 | Onc dx cml dx status unknown | Description: Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project) |
| G9140 | Frontier extended stay demo | Description: Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours |
| G9143 | Warfarin respon genetic test | Description: Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s) |
| G9147 | Outpt iv insulin tx any mea | Description: Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration |
| G9148 | Medical home level 1 | Description: National committee for quality assurance - level 1 medical home |
| G9149 | Medical home level ii | Description: National committee for quality assurance - level 2 medical home |
| G9150 | Medical home level iii | Description: National committee for quality assurance - level 3 medical home |
| G9151 | Mapcp demo state | Description: Mapcp demonstration - state provided services |
| G9152 | Mapcp demo community | Description: Mapcp demonstration - community health teams |
| G9153 | Mapcp demo physician | Description: Mapcp demonstration - physician incentive pool |
| G9156 | Evaluation for wheelchair | Description: Evaluation for wheelchair requiring face to face visit with physician |
| G9157 | Transesoph doppl cardiac mon | Description: Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes |
| G9187 | Bpci home visit | Description: Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code |
| G9188 | Beta not given no reason | Description: Beta-blocker therapy not prescribed, reason not given |
| G9189 | Beta pres or already taking | Description: Beta-blocker therapy prescribed or currently being taken |
| G9190 | Medical reason for no beta | Description: Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons) |
| G9191 | Pt reason for no beta | Description: Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) |
| G9212 | Doc of dsm-iv init eval | Description: Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation |
| G9213 | No doc of dsm-iv | Description: Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified |
| G9223 | Pjp proph ordered cd4 low | Description: Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% |
| G9225 | Norsn no foot exam | Description: Foot exam was not performed, reason not given |
| G9226 | 3 comp foot exam completed | Description: Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed) |
| G9227 | Foa doc, care plan not doc | Description: Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter |
| G9228 | Gc chl syp documented | Description: Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) |
| G9230 | Norsn for gc chl syp test | Description: Chlamydia, gonorrhea, and syphilis not screened, reason not given |
| G9231 | Doc esrd dia trans preg | Description: Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period |
| G9242 | Doc viral load >=200 | Description: Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed |
| G9243 | Doc viral load <200 | Description: Documentation of viral load less than 200 copies/ml |
| G9273 | Sys<140 and dia<90 | Description: Blood pressure has a systolic value of < 140 and a diastolic value of < 90 |
| G9274 | Bp out of nrml limits | Description: Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90 |
| G9275 | Doc of non tobacco user | Description: Documentation that patient is a current non-tobacco user |
| G9276 | Doc of tobacco user | Description: Documentation that patient is a current tobacco user |
| G9277 | Doc daily aspirin or contra | Description: Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux) |
| G9278 | Doc no daily aspirin | Description: Documentation that the patient is not on daily aspirin or anti-platelet regimen |
| G9279 | Pne scrn done doc vac done | Description: Pneumococcal screening performed and documentation of vaccination received prior to discharge |
| G9280 | Pne not given norsn | Description: Pneumococcal vaccination not administered prior to discharge, reason not specified |
| G9281 | Pne scrn done doc not ind | Description: Screening performed and documentation that vaccination not indicated/patient refusal |
| G9282 | Doc medrsn no histo type | Description: Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons) |
| G9283 | Hist type doc on report | Description: Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9284 | No hist type doc on report | Description: Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9285 | Site not small cell lung ca | Description: Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer |
| G9286 | Antibio rx w in 10d of sympt | Description: Antibiotic regimen prescribed within 10 days after onset of symptoms |
| G9287 | No antibio w in 10d of sympt | Description: Antibiotic regimen not prescribed within 10 days after onset of symptoms |
| G9288 | Doc medrsn no hist type rpt | Description: Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons) |
| G9289 | Doc type nsm lung ca | Description: Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9290 | No doc type nsm lung ca | Description: Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9291 | Not nsm lung ca | Description: Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos |
| G9292 | Medrsn no pt category | Description: Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons) |
| G9293 | No pt category on report | Description: Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
| G9294 | Pt cat and thck on report | Description: Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
| G9295 | Non cutaneous loc | Description: Specimen site other than anatomic cutaneous location |
| G9296 | Doc share dec prior proc | Description: Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure |
| G9297 | No doc share dec prior proc | Description: Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure, not documented, reason not given |
| G9298 | Eval risk vte card 30d prior | Description: Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke) |
| G9299 | No eval risk vte card prior | Description: Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given) |
| G9305 | No interv req for leak | Description: Intervention for presence of leak of endoluminal contents through an anastomosis not required |
| G9306 | Interv req for leak | Description: Intervention for presence of leak of endoluminal contents through an anastomosis required |
| G9307 | No ret for surg w in 30d | Description: No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure |
| G9308 | Unpl ret or w/compl w/in 30d | Description: Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure |
| G9309 | No unplnd hosp readm in 30d | Description: No unplanned hospital readmission within 30 days of principal procedure |
| G9310 | Unplnd hosp readm in 30d | Description: Unplanned hospital readmission within 30 days of principal procedure |
| G9311 | No surg site infection | Description: No surgical site infection |
| G9312 | Surgical site infection | Description: Surgical site infection |
| G9313 | Amoxic not presc as 1st line | Description: Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason |
| G9314 | Norsn not first line amox | Description: Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given |
| G9315 | Amox w/wo clav rx | Description: Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis |
| G9316 | Doc comm risk calc | Description: Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family |
| G9317 | No doc comm risk calc | Description: Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed |
| G9318 | Image std nomenclature | Description: Imaging study named according to standardized nomenclature |
| G9319 | Image not std nomenclature | Description: Imaging study not named according to standardized nomenclature, reason not given |
| G9341 | Srch for ct w in 12 mos | Description: Search conducted for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed |
| G9342 | No srch for ct in 12mo norsn | Description: Search not conducted prior to an imaging study being performed for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive, reason not given |
| G9344 | Sysrsn no dicom srch | Description: Due to system reasons search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., non-affiliated external healthcare facilities or entities does not have archival abilities through a shared archival system) |
| G9345 | Follow up pulm nod | Description: Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors |
| G9347 | No follow up pulm nod norsn | Description: Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given |
| G9351 | Doc >1 sinus ct w 90d dx | Description: More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis |
| G9352 | Not >1 sinus ct w 90d dx | Description: More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given |
| G9353 | Medrsn >1 sinus ct w 90d dx | Description: More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with complications, second ct obtained prior to surgery, other medical reasons) |
| G9354 | 1 or no ct sinus w/in 90d dx | Description: One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis |
| G9355 | No early ind/delivery | Description: Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation) |
| G9356 | Early ind/delivery | Description: Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation) |
| G9357 | Pp eval/edu perf | Description: Post-partum screenings, evaluations and education performed |
| G9358 | Pp eval/edu not perf | Description: Post-partum screenings, evaluations and education not performed |
| 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)] |
| G9364 | Sinus caus bac inx | Description: Sinusitis caused by, or presumed to be caused by, bacterial infection |
| 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 |
| 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 |
| 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 |
| 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) |
| 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 |
| G9414 | 1dose menig vac btwn 11 & 13 | Description: Patient had one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient's 11th and 13th birthdays |
| G9415 | No 1dose meni vac btwn 11&13 | Description: Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient's 11th and 13th birthdays |
| G9416 | 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 |
| 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 |
| G9452 | Doc med reas no hcv test | Description: Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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) |
| 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 |
| 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 |
| 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 |
| 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 |
| G9537 | Img hd clin trial | Description: Imaging needed as part of a clinical trial; or other clinician ordered the study |
| 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 |
| G9580 | Door to punc time <2hrs | Description: Door to puncture time of 90 minutes or less |
| G9582 | Door to punc time >2hr, nrg | Description: Door to puncture time of greater than 90 minutes, no reason given |
| 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 |
| 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 |
| G9603 | Pt surv improv bsline tx | Description: Patient survey score improved from baseline following treatment |
| G9604 | Pt surv results not avail | Description: Patient survey results not available |
| 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 |
| 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 |
| 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 |
| 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) |
| 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 |
| 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)) |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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) |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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) |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| G9788 | Most rct bp </= 140/90 | Description: Most recent bp is less than or equal to 140/90 mm hg |
| G9789 | Record bp ip, er, urg/self | Description: Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits |
| G9790 | Most rct bp >/= 140/90 | Description: Most recent bp is greater than 140/90 mm hg, or blood pressure not documented |
| 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 |
| G9796 | Pt not currently on statin | Description: Patient is currently on a statin therapy |
| G9797 | Pt currently on statin | Description: Patient is not on a statin therapy |
| 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 |
| 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 |
| 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 |
| 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 |
| G9832 | Brt ca dx i, no t1/t1a/t1b | Description: Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis does not equal = t1, t1a, t1b |
| 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 |
| 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 |