G Codes
- Bart Rogacewicz
G0008 | Administration of influenza virus vaccine |
G0009 | Administration of pneumococcal vaccine |
G0010 | Administration of hepatitis b vaccine |
G0027 | Semen analysis; presence and/or motility of sperm excluding huhner |
G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination |
G0102 | Prostate cancer screening; digital rectal examination |
G0103 | Prostate cancer screening; prostate specific antigen test (psa) |
G0104 | Colorectal cancer screening; flexible sigmoidoscopy |
G0105 | Colorectal cancer screening; colonoscopy on individual at high risk |
G0106 | Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema |
G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes |
G0109 | Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes |
G0117 | Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
G0118 | Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist |
G0120 | Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema. |
G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
G0122 | Colorectal cancer screening; barium enema |
G0123 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision |
G0124 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician |
G0127 | Trimming of dystrophic nails, any number |
G0128 | Direct (face-to-face with patient) skilled nursing services of a registered nurse provided in a comprehensive outpatient rehabilitation facility, each 10 minutes beyond the first 5 minutes |
G0129 | Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization treatment program, per session (45 minutes or more) |
G0130 | Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) |
G0141 | Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician |
G0143 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision |
G0144 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision |
G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
G0147 | Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision |
G0148 | Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening |
G0151 | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes |
G0152 | Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes |
G0153 | Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes |
G0154 | Direct skilled nursing services of a licensed nurse (lpn or rn) in the home health or hospice setting, each 15 minutes |
G0155 | Services of clinical social worker in home health or hospice settings, each 15 minutes |
G0156 | Services of home health/hospice aide in home health or hospice settings, each 15 minutes |
G0157 | Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes |
G0158 | Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes |
G0159 | Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes |
G0160 | Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes |
G0161 | Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes |
G0162 | Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting) |
G0163 | Skilled services of a licensed nurse (lpn or rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
G0164 | Skilled services of a licensed nurse (lpn or rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes |
G0166 | External counterpulsation, per treatment session |
G0168 | Wound closure utilizing tissue adhesive(s) only |
G0173 | Linear accelerator based stereotactic radiosurgery, complete course of therapy in one session |
G0175 | Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present |
G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) |
G0177 | Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) |
G0179 | Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per re-certification period |
G0180 | Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient's needs, per certification period |
G0181 | Physician supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more |
G0182 | Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more |
G0186 | Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions) |
G0202 | Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed |
G0204 | Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral |
G0206 | Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral |
G0219 | Pet imaging whole body; melanoma for non-covered indications |
G0235 | Pet imaging, any site, not otherwise specified |
G0237 | Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) |
G0238 | Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) |
G0239 | Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) |
G0245 | Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education |
G0246 | Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education |
G0247 | Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails |
G0248 | Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results |
G0249 | Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests |
G0250 | Physician review, interpretation, and patient management of home inr testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include 4 tests |
G0251 | Linear accelerator based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, maximum five sessions per course of treatment |
G0252 | Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (e.g., initial staging of axillary lymph nodes) |
G0255 | Current perception threshold/sensory nerve conduction test, (snct) per limb, any nerve |
G0257 | Unscheduled or emergency dialysis treatment for an esrd patient in a hospital outpatient department that is not certified as an esrd facility |
G0259 | Injection procedure for sacroiliac joint; arthrograpy |
G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography |
G0268 | Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing |
G0269 | Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug) |
G0270 | Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes |
G0271 | Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes |
G0275 | Renal angiography, non-selective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins (ostia) of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure) |
G0276 | Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial |
G0277 | Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval |
G0278 | Iliac and/or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure) |
G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to g0204 or g0206) |
G0281 | Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care |
G0282 | Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281 |
G0283 | Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
G0288 | Reconstruction, computed tomographic angiography of aorta for surgical planning for vascular surgery |
G0289 | Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee |
G0293 | Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a medicare qualifying clinical trial, per day |
G0294 | Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day |
G0295 | Electromagnetic therapy, to one or more areas, for wound care other than described in g0329 or for other uses |
G0296 | Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) |
G0297 | Low dose ct scan (ldct) for lung cancer screening |
G0299 | Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
G0300 | Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes |
G0302 | Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services |
G0303 | Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services |
G0304 | Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services |
G0305 | Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services |
G0306 | Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count |
G0307 | Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count) |
G0328 | Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous |
G0329 | Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care as part of a therapy plan of care |
G0333 | Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary |
G0337 | Hospice evaluation and counseling services, pre-election |
G0339 | Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment |
G0340 | Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatment |
G0341 | Percutaneous islet cell transplant, includes portal vein catheterization and infusion |
G0342 | Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion |
G0343 | Laparotomy for islet cell transplant, includes portal vein catheterization and infusion |
G0364 | Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service |
G0365 | Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow) |
G0372 | Physician service required to establish and document the need for a power mobility device |
G0378 | Hospital observation service, per hour |
G0379 | Direct admission of patient for hospital observation care |
G0380 | Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
G0381 | Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
G0382 | Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
G0383 | Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
G0384 | Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment) |
G0389 | Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening |
G0390 | Trauma response team associated with hospital critical care service |
G0396 | Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes |
G0397 | Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes |
G0398 | Home sleep study test (hst) with type ii portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and oxygen saturation |
G0399 | Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation |
G0400 | Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3 channels |
G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment |
G0403 | Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report |
G0404 | Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination |
G0405 | Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination |
G0406 | Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth |
G0407 | Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth |
G0408 | Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth |
G0409 | Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a corf-qualified social worker or psychologist in a corf) |
G0410 | Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes |
G0411 | Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes |
G0412 | Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed |
G0413 | Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum) |
G0414 | Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami) |
G0415 | Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum) |
G0416 | Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method |
G0417 | Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens |
G0418 | Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens |
G0419 | Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens |
G0420 | Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour |
G0421 | Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour |
G0422 | Intensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session |
G0423 | Intensive cardiac rehabilitation; with or without continuous ecg monitoring; without exercise, per session |
G0424 | Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day |
G0425 | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth |
G0426 | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth |
G0427 | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth |
G0428 | Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex) |
G0429 | Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy) |
G0431 | Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter |
G0432 | Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening |
G0433 | Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening |
G0434 | Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter |
G0435 | Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening |
G0436 | Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes |
G0437 | Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes |
G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
G0442 | Annual alcohol misuse screening, 15 minutes |
G0443 | Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes |
G0444 | Annual depression screening, 15 minutes |
G0445 | High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes |
G0446 | Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes |
G0447 | Face-to-face behavioral counseling for obesity, 15 minutes |
G0448 | Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing |
G0451 | Development testing, with interpretation and report, per standardized instrument form |
G0452 | Molecular pathology procedure; physician interpretation and report |
G0453 | Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) |
G0454 | Physician documentation of face-to-face visit for durable medical equipment determination performed by nurse practitioner, physician assistant or clinical nurse specialist |
G0455 | Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen |
G0456 | Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters |
G0457 | Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters |
G0458 | Low dose rate (ldr) prostate brachytherapy services, composite rate |
G0459 | Inpatient telehealth pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy |
G0460 | Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment |
G0461 | Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain |
G0462 | Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) |
G0463 | Hospital outpatient clinic visit for assessment and management of a patient |
G0464 | Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3) |
G0466 | Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
G0467 | Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
G0468 | Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
G0469 | Federally qualified health center (fqhc) visit, mental health, new patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit |
G0470 | Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit |
G0471 | Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) |
G0472 | Hepatitis c antibody screening, for individual at high risk and other covered indication(s) |
G0473 | Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes |
G0475 | Hiv antigen/antibody, combination assay, screening |
G0476 | Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test |
G0477 | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service |
G0478 | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) read by instrument-assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service |
G0479 | Drug test(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme assay, tof, maldi, ldtd, desi, dart, ghpc, gc mass spectrometry), includes sample validation when performed, per date of service |
G0480 | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed |
G0481 | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed |
G0482 | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed |
G0483 | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed |
G0490 | Face-to-face home health nursing visit by a rural health clinic (rhc) or federally qualified health center (fqhc) in an area with a shortage of home health agencies; (services limited to rn or lpn only) |
G0491 | Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd |
G0492 | Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd |
G0493 | Skilled services of a registered nurse (rn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
G0494 | Skilled services of a licensed practical nurse (lpn) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting) |
G0495 | Skilled services of a registered nurse (rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes |
G0496 | Skilled services of a licensed practical nurse (lpn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes |
G0498 | Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion |
G0499 | Hepatitis b screening in non-pregnant, high risk individual includes hepatitis b surface antigen (hbsag) followed by a neutralizing confirmatory test for initially reactive results, and antibodies to hbsag (anti-hbs) and hepatitis b core antigen (anti-hbc) |
G0500 | Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) |
G0501 | Resource-intensive services for patients for whom the use of specialized mobility-assistive technology (such as adjustable height chairs or tables, patient lift, and adjustable padded leg supports) is medically necessary and used during the provision of an office/outpatient, evaluation and management visit (list separately in addition to primary service) |
G0502 | Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies |
G0503 | Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment |
G0504 | Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (list separately in addition to code for primary procedure); (use g0504 in conjunction with g0502, g0503) |
G0505 | Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, in office or other outpatient setting or home or domiciliary or rest home |
G0506 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) |
G0507 | Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team |
G0508 | Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth |
G0509 | Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth |
G0908 | Most recent hemoglobin (hgb) level > 12.0 g/dl |
G0909 | Hemoglobin level measurement not documented, reason not given |
G0910 | Most recent hemoglobin level <= 12.0 g/dl |
G0913 | Improvement in visual function achieved within 90 days following cataract surgery |
G0914 | Patient care survey was not completed by patient |
G0915 | Improvement in visual function not achieved within 90 days following cataract surgery |
G0916 | Satisfaction with care achieved within 90 days following cataract surgery |
G0917 | Patient satisfaction survey was not completed by patient |
G0918 | Satisfaction with care not achieved within 90 days following cataract surgery |
G0919 | Influenza immunization ordered or recommended (to be given at alternate location or alternate provider); vaccine not available at time of visit |
G0920 | Type, anatomic location, and activity all documented |
G0921 | Documentation of patient reason(s) for not being able to assess (e.g., patient refuses endoscopic and/or radiologic assessment) |
G0922 | No documentation of disease type, anatomic location, and activity, reason not given |
G3001 | Administration and supply of tositumomab, 450 mg |
G6001 | Ultrasonic guidance for placement of radiation therapy fields |
G6002 | Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy |
G6003 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: up to 5 mev |
G6004 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 6-10 mev |
G6005 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 11-19 mev |
G6006 | Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 20 mev or greater |
G6007 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5 mev |
G6008 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-10 mev |
G6009 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 11-19 mev |
G6010 | Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater |
G6011 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5 mev |
G6012 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-10 mev |
G6013 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev |
G6014 | Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20 mev or greater |
G6015 | Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session |
G6016 | Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session |
G6017 | Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg,3d positional tracking, gating, 3d surface tracking), each fraction of treatment |
G6018 | Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation) |
G6019 | Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique |
G6020 | Colonoscopy through stoma; with transendoscopic stent placement (includes predilation) |
G6021 | Unlisted procedure, intestine |
G6022 | Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique |
G6023 | Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation) |
G6024 | Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique |
G6025 | Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation) |
G6027 | Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed |
G6028 | Anoscopy, high resolution (hra) (with magnification and chemical agent enhancement); with biopsy(ies) |
G6030 | Amitriptyline |
G6031 | Benzodiazepines |
G6032 | Desipramine |
G6034 | Doxepin |
G6035 | Gold |
G6036 | Assay of imipramine |
G6037 | Nortriptyline |
G6038 | Salicylate |
G6039 | Acetaminophen |
G6040 | Alcohol (ethanol); any specimen except breath |
G6041 | Alkaloids, urine, quantitative |
G6042 | Amphetamine or methamphetamine |
G6043 | Barbiturates, not elsewhere specified |
G6044 | Cocaine or metabolite |
G6045 | Dihydrocodeinone |
G6046 | Dihydromorphinone |
G6047 | Dihydrotestosterone |
G6048 | Dimethadione |
G6049 | Epiandrosterone |
G6050 | Ethchlorvynol |
G6051 | Flurazepam |
G6052 | Meprobamate |
G6053 | Methadone |
G6054 | Methsuximide |
G6055 | Nicotine |
G6056 | Opiate(s), drug and metabolites, each procedure |
G6057 | Phenothiazine |
G6058 | Drug confirmation, each procedure |
G8126 | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase |
G8127 | Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase |
G8128 | Clinician documented that patient was not an eligible candidate for antidepressant medication during the entire 12 week acute treatment phase measure |
G8395 | Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function |
G8396 | Left ventricular ejection fraction (lvef) not performed or documented |
G8397 | Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy |
G8398 | Dilated macular or fundus exam not performed |
G8399 | Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed |
G8400 | Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given |
G8401 | Clinician documented that patient was not an eligible candidate for screening |
G8404 | Lower extremity neurological exam performed and documented |
G8405 | Lower extremity neurological exam not performed |
G8406 | Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure |
G8410 | Footwear evaluation performed and documented |
G8415 | Footwear evaluation was not performed |
G8416 | Clinician documented that patient was not an eligible candidate for footwear evaluation measure |
G8417 | Bmi is documented above normal parameters and a follow-up plan is documented |
G8418 | Bmi is documented below normal parameters and a follow-up plan is documented |
G8419 | Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
G8420 | Bmi is documented within normal parameters and no follow-up plan is required |
G8421 | Bmi not documented and no reason is given |
G8422 | Bmi not documented, documentation the patient is not eligible for bmi calculation |
G8427 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
G8428 | Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
G8430 | Eligible clinician attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible clinician |
G8431 | Screening for depression is documented as being positive and a follow-up plan is documented |
G8432 | Depression screening not documented, reason not given |
G8433 | Screening for depression not completed, documented reason |
G8442 | Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool |
G8450 | Beta-blocker therapy prescribed |
G8451 | Beta-blocker therapy for lvef < 40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons, or other reasons attributable to the healthcare system) |
G8452 | Beta-blocker therapy not prescribed |
G8458 | Clinician documented that patient is not an eligible candidate for genotype testing; patient not receiving antiviral treatment for hepatitis c during the measurement period (e.g. genotype test done prior to the reporting period, patient declines, patient not a candidate for antiviral treatment) |
G8459 | Clinician documented that patient is receiving antiviral treatment for hepatitis c |
G8460 | Clinician documented that patient is not an eligible candidate for quantitative rna testing at week 12; patient not receiving antiviral treatment for hepatitis c |
G8461 | Patient receiving antiviral treatment for hepatitis c during the measurement period |
G8462 | Clinician documented that patient is not an eligible candidate for counseling regarding contraception prior to antiviral treatment; patient not receiving antiviral treatment for hepatitis c |
G8463 | Patient receiving antiviral treatment for hepatitis c documented |
G8464 | Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined |
G8465 | High or very high risk of recurrence of prostate cancer |
G8473 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed |
G8474 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons) or (e.g., lack of drug availability, other reasons attributable to the health care system) |
G8475 | Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given |
G8476 | Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg |
G8477 | Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg |
G8478 | Blood pressure measurement not performed or documented, reason not given |
G8482 | Influenza immunization administered or previously received |
G8483 | Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
G8484 | Influenza immunization was not administered, reason not given |
G8485 | I intend to report the diabetes mellitus (dm) measures group |
G8486 | I intend to report the preventive care measures group |
G8487 | I intend to report the chronic kidney disease (ckd) measures group |
G8489 | I intend to report the coronary artery disease (cad) measures group |
G8490 | I intend to report the rheumatoid arthritis (ra) measures group |
G8491 | I intend to report the hiv/aids measures group |
G8492 | I intend to report the perioperative care measures group |
G8493 | I intend to report the back pain measures group |
G8494 | All quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient |
G8495 | All quality actions for the applicable measures in the chronic kidney disease (ckd) measures group have been performed for this patient |
G8496 | All quality actions for the applicable measures in the preventive care measures group have been performed for this patient |
G8497 | All quality actions for the applicable measures in the coronary artery bypass graft (cabg) measures group have been performed for this patient |
G8498 | All quality actions for the applicable measures in the coronary artery disease (cad) measures group have been performed for this patient |
G8499 | All quality actions for the applicable measures in the rheumatoid arthritis (ra) measures group have been performed for this patient |
G8500 | All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient |
G8501 | All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient |
G8502 | All quality actions for the applicable measures in the back pain measures group have been performed for this patient |
G8506 | Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy |
G8509 | Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given |
G8510 | Screening for depression is documented as negative, a follow-up plan is not required |
G8511 | Screening for depression documented as positive, follow-up plan not documented, reason not given |
G8530 | Autogenous av fistula received |
G8531 | Clinician documented that patient was not an eligible candidate for autogenous av fistula |
G8532 | Clinician documented that patient received vascular access other than autogenous av fistula, reason not given |
G8535 | Elder maltreatment screen not documented; documentation that patient not eligible for the elder maltreatment screen |
G8536 | No documentation of an elder maltreatment screen, reason not given |
G8539 | Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies on the date of functional outcome assessment, is documented |
G8540 | Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool |
G8541 | Functional outcome assessment using a standardized tool not documented, reason not given |
G8542 | Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required |
G8543 | Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given |
G8544 | I intend to report the coronary artery bypass graft (cabg) measures group |
G8545 | I intend to report the hepatitis c measures group |
G8547 | I intend to report the ischemic vascular disease (ivd) measures group |
G8548 | I intend to report the heart failure (hf) measures group |
G8549 | All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patient |
G8551 | All quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient |
G8552 | All quality actions for the applicable measures in the ischemic vascular disease (ivd) measures group have been performed for this patient |
G8553 | Prescription(s) generated and transmitted via a qualified erx system |
G8556 | Referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation |
G8557 | Patient is not eligible for the referral for otologic evaluation measure |
G8558 | Not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given |
G8559 | Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation |
G8560 | Patient has a history of active drainage from the ear within the previous 90 days |
G8561 | Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure |
G8562 | Patient does not have a history of active drainage from the ear within the previous 90 days |
G8563 | Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given |
G8564 | Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified) |
G8565 | Verification and documentation of sudden or rapidly progressive hearing loss |
G8566 | Patient is not eligible for the "referral for otologic evaluation for sudden or rapidly progressive hearing loss" measure |
G8567 | Patient does not have verification and documentation of sudden or rapidly progressive hearing loss |
G8568 | Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given |
G8569 | Prolonged postoperative intubation (> 24 hrs) required |
G8570 | Prolonged postoperative intubation (> 24 hrs) not required |
G8571 | Development of deep sternal wound infection/mediastinitis within 30 days postoperatively |
G8572 | No deep sternal wound infection/mediastinitis |
G8573 | Stroke following isolated cabg surgery |
G8574 | No stroke following isolated cabg surgery |
G8575 | Developed postoperative renal failure or required dialysis |
G8576 | No postoperative renal failure/dialysis not required |
G8577 | Re-exploration required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason |
G8578 | Re-exploration not required due to mediastinal bleeding with or without tamponade, graft occlusion, valve dysfunction or other cardiac reason |
G8579 | Antiplatelet medication at discharge |
G8580 | Antiplatelet medication contraindicated |
G8581 | No antiplatelet medication at discharge |
G8582 | Beta-blocker at discharge |
G8583 | Beta-blocker contraindicated |
G8584 | No beta-blocker at discharge |
G8585 | Anti-lipid treatment at discharge |
G8586 | Anti-lipid treatment contraindicated |
G8587 | No anti-lipid treatment at discharge |
G8588 | Most recent systolic blood pressure < 140 mmhg |
G8589 | Most recent systolic blood pressure >= 140 mmhg |
G8590 | Most recent diastolic blood pressure < 90 mmhg |
G8591 | Most recent diastolic blood pressure >= 90 mmhg |
G8592 | No documentation of blood pressure measurement, reason not given |
G8593 | Lipid profile results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) |
G8594 | Lipid profile not performed, reason not given |
G8595 | Most recent ldl-c < 100 mg/dl |
G8596 | Ldl-c was not performed |
G8597 | Most recent ldl-c >= 100 mg/dl |
G8598 | Aspirin or another antiplatelet therapy used |
G8599 | Aspirin or another antiplatelet therapy not used, reason not given |
G8600 | Iv t-pa initiated within three hours (<= 180 minutes) of time last known well |
G8601 | Iv t-pa not initiated within three hours (<= 180 minutes) of time last known well for reasons documented by clinician |
G8602 | Iv t-pa not initiated within three hours (<= 180 minutes) of time last known well, reason not given |
G8603 | Score on the spoken language comprehension functional communication measure at discharge was higher than at admission |
G8604 | Score on the spoken language comprehension functional communication measure at discharge was not higher than at admission, reason not given |
G8605 | Patient treated for spoken language comprehension but not scored on the spoken language comprehension functional communication measure either at admission or at discharge |
G8606 | Score on the attention functional communication measure at discharge was higher than at admission |
G8607 | Score on the attention functional communication measure at discharge was not higher than at admission, reason not given |
G8608 | Patient treated for attention but not scored on the attention functional communication measure either at admission or at discharge |
G8609 | Score on the memory functional communication measure at discharge was higher than at admission |
G8610 | Score on the memory functional communication measure at discharge was not higher than at admission, reason not given |
G8611 | Patient treated for memory but not scored on the memory functional communication measure either at admission or at discharge |
G8612 | Score on the motor speech functional communication measure at discharge was higher than at admission |
G8613 | Score on the motor speech functional communication measure at discharge was not higher than at admission, reason not given |
G8614 | Patient treated for motor speech but not scored on the motor speech comprehension functional communication measure either at admission or at discharge |
G8615 | Score on the reading functional communication measure at discharge was higher than at admission |
G8616 | Score on the reading functional communication measure at discharge was not higher than at admission, reason not given |
G8617 | Patient treated for reading but not scored on the reading functional communication measure either at admission or at discharge |
G8618 | Score on the spoken language expression functional communication measure at discharge was higher than at admission |
G8619 | Score on the spoken language expression functional communication measure at discharge was not higher than at admission, reason not given |
G8620 | Patient treated for spoken language expression but not scored on the spoken language expression functional communication measure either at admission or at discharge |
G8621 | Score on the writing functional communication measure at discharge was higher than at admission |
G8622 | Score on the writing functional communication measure at discharge was not higher than at admission, reason not given |
G8623 | Patient treated for writing but not scored on the writing functional communication measure either at admission or at discharge |
G8624 | Score on the swallowing functional communication measure at discharge was higher than at admission |
G8625 | Score on the swallowing functional communication measure at discharge was not higher than at admission, reason not given |
G8626 | Patient treated for swallowing but not scored on the swallowing functional communication measure at admission or at discharge |
G8627 | Surgical procedure performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence) |
G8628 | Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence) |
G8629 | Documentation of order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required) |
G8630 | Documentation that administration of prophylactic parenteral antibiotics was initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required), as ordered |
G8631 | Clinician documented that patient was not an eligible candidate for ordering prophylactic parenteral antibiotics to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required) |
G8632 | Prophylactic parenteral antibiotics were not ordered to be given or given within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required), reason not given |
G8633 | Pharmacologic therapy (other than minierals/vitamins) for osteoporosis prescribed |
G8634 | Clinician documented patient not an eligible candidate to receive pharmacologic therapy for osteoporosis |
G8635 | Pharmacologic therapy for osteoporosis was not prescribed, reason not given |
G8642 | The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(a) of the social security act |
G8643 | The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption for the application of the payment adjustment under section 1848(a)(5)(a) of the social security act |
G8644 | Eligible professional does not have prescribing privileges |
G8645 | I intend to report the asthma measures group |
G8646 | All quality actions for the applicable measures in the asthma measures group have been performed for this patient |
G8647 | Risk-adjusted functional status change residual score for the knee successfully calculated and the score was equal to zero (0) or greater than zero (>0) |
G8648 | Risk-adjusted functional status change residual score for the knee successfully calculated and the score was less than zero (<0) |
G8649 | Risk-adjusted functional status change residual scores for the knee not measured because the patient did not complete foto's status survey near discharge, not appropriate |
G8650 | Risk-adjusted functional status change residual scores for the knee not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given |
G8651 | Risk-adjusted functional status change residual score for the hip successfully calculated and the score was equal to zero (0) or greater than zero (>0) |
G8652 | Risk-adjusted functional status change residual score for the hip successfully calculated and the score was less than zero (<0) |
G8653 | Risk-adjusted functional status change residual scores for the hip not measured because the patient did not complete follow up status survey near discharge, patient not appropriate |
G8654 | Risk-adjusted functional status change residual scores for the hip not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given |
G8655 | Risk-adjusted functional status change residual score for the foot or ankle successfully calculated and the score was equal to zero (0) or greater than zero ( > 0) |
G8656 | Risk-adjusted functional status change residual score for the foot or ankle successfully calculated and the score was less than zero (< 0) |
G8657 | Risk-adjusted functional status change residual scores for the foot or ankle not measured because the patient did not complete foto's status survey near discharge, patient not appropriate |
G8658 | Risk-adjusted functional status change residual scores for the foot or ankle not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given |
G8659 | Risk-adjusted functional status change residual score for the lumbar impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
G8660 | Risk-adjusted functional status change residual score for the lumbar impairment successfully calculated and the score was less than zero (< 0) |
G8661 | Risk-adjusted functional status change residual scores for the lumbar impairment not measured because the patient did not complete foto's status survey near discharge, patient not appropriate |
G8662 | Risk-adjusted functional status change residual scores for the lumbar impairment not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given |
G8663 | Risk-adjusted functional status change residual score for the shoulder successfully calculated and the score was equal to zero (0) or greater than zero (>0) |
G8664 | Risk-adjusted functional status change residual score for the shoulder successfully calculated and the score was less than zero (<0) |
G8665 | Risk-adjusted functional status change residual scores for the shoulder not measured because the patient did not complete foto's functional status survey near discharge, patient not appropriate |
G8666 | Risk-adjusted functional status change residual scores for the shoulder not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given |
G8667 | Risk-adjusted functional status change residual score for the elbow, wrist or hand successfully calculated and the score was equal to zero (0) or greater than zero (>0) |
G8668 | Risk-adjusted functional status change residual score for the elbow, wrist or hand successfully calculated and the score was less than zero (<0) |
G8669 | Risk-adjusted functional status change residual scores for the elbow, wrist or hand not measured because the patient did not complete foto's functional follow up status survey near discharge, patient not appropriate |
G8670 | Risk-adjusted functional status change residual scores for the elbow, wrist or hand not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given |
G8671 | Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs, or other general orthopaedic impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0) |
G8672 | Risk-adjusted functional status change residual score for the neck, cranium, mandible, thoracic spine, ribs, or other general orthopaedic impairment successfully calculated and the score was less than zero (< 0) |
G8673 | Risk-adjusted functional status change residual scores for the neck, cranium, mandible, thoracic spine, ribs, or other general orthopaedic impairment not measured because the patient did not complete foto's functional follow up status survey near discharge, patient not appropriate |
G8674 | Risk-adjusted functional status change residual scores for the neck, cranium, mandible, thoracic spine, ribs, or other general orthopaedic impairment not measured because the patient did not complete foto's functional intake on admission and/or follow up status survey near discharge, reason not given |
G8682 | Lvf testing documented as being performed prior to discharge or in the previous 12 months |
G8683 | Lvf testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason |
G8685 | Lvf testing not documented as being performed prior to discharge or in the previous 12 months, reason not given |
G8694 | Left ventricular ejection fraction (lvef) < 40% |
G8696 | Antithrombotic therapy prescribed at discharge |
G8697 | Antithrombotic therapy not prescribed for documented reasons (e.g., patient had stroke during hospital stay, patient expired during inpatient stay, other medical reason(s)); (e.g., patient left against medical advice, other patient reason(s)) |
G8698 | Antithrombotic therapy was not prescribed at discharge, reason not given |
G8699 | Rehabilitation services (occupational, physical or speech) ordered at or prior to discharge |
G8700 | Rehabilitation services (occupational, physical or speech) not indicated at or prior to discharge |
G8701 | Rehabilitation services were not ordered, reason not otherwise specified |
G8702 | Documentation that prophylactic antibiotics were given within 4 hours prior to surgical incision or intraoperatively |
G8703 | Documentation that prophylactic antibiotics were neither given within 4 hours prior to surgical incision nor intraoperatively |
G8704 | 12-lead electrocardiogram (ecg) performed |
G8705 | Documentation of medical reason(s) for not performing a 12-lead electrocardiogram (ecg) |
G8706 | Documentation of patient reason(s) for not performing a 12-lead electrocardiogram (ecg) |
G8707 | 12-lead electrocardiogram (ecg) not performed, reason not given |
G8708 | Patient not prescribed or dispensed antibiotic |
G8709 | Patient prescribed or dispensed antibiotic for documented medical reason(s) (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases (female reproductive organs)), infections of the kidney, cystitis or uti, and acne) |
G8710 | Patient prescribed or dispensed antibiotic |
G8711 | Prescribed or dispensed antibiotic |
G8712 | Antibiotic not prescribed or dispensed |
G8713 | Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] / volume [v]) |
G8714 | Hemodialysis treatment performed exactly three times per week for > 90 days |
G8717 | Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason not given |
G8718 | Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt] / volume [v]) |
G8720 | Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v]) |
G8721 | Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report |
G8722 | Documentation of medical reason(s) for not including the pt category, the pn category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; non-carcinomasanal canal) |
G8723 | Specimen site is other than anatomic location of primary tumor |
G8724 | Pt category, pn category and histologic grade were not documented in the pathology report, reason not given |
G8725 | Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total cholesterol) |
G8726 | Clinician has documented reason for not performing fasting lipid profile (e.g., patient declined, other patient reasons) |
G8728 | Fasting lipid profile not performed, reason not given |
G8730 | Pain assessment documented as positive using a standardized tool and a follow-up plan is documented |
G8731 | Pain assessment using a standardized tool is documented as negative, no follow-up plan required |
G8732 | No documentation of pain assessment, reason not given |
G8733 | Elder maltreatment screen documented as positive and a follow-up plan is documented |
G8734 | Elder maltreatment screen documented as negative, no follow-up required |
G8735 | Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given |
G8736 | Most current ldl-c <100mg/dl |
G8737 | Most current ldl-c >=100mg/dl |
G8738 | Left ventricular ejection fraction (lvef) < 40% or documentation of severely or moderately depressed left ventricular systolic function |
G8739 | Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function |
G8740 | Left ventricular ejection fraction (lvef) not performed or assessed, reason not given |
G8741 | Patient not treated for spoken language comprehension disorder |
G8742 | Patient not treated for attention disorder |
G8743 | Patient not treated for memory disorder |
G8744 | Patient not treated for motor speech disorder |
G8745 | Patient not treated for reading disorder |
G8746 | Patient not treated for spoken language expression disorder |
G8747 | Patient not treated for writing disorder |
G8748 | Patient not treated for swallowing disorder |
G8749 | Absence of signs of melanoma (cough, dyspnea, tenderness, localized neurologic signs such as weakness, jaundice or any other sign suggesting systemic spread) or absence of symptoms of melanoma (pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma) |
G8751 | Smoking status and exposure to second hand smoke in the home not assessed, reason not given |
G8752 | Most recent systolic blood pressure < 140 mmhg |
G8753 | Most recent systolic blood pressure >= 140 mmhg |
G8754 | Most recent diastolic blood pressure < 90 mmhg |
G8755 | Most recent diastolic blood pressure >= 90 mmhg |
G8756 | No documentation of blood pressure measurement, reason not given |
G8757 | All quality actions for the applicable measures in the chronic obstructive pulmonary disease (copd) measures group have been performed for this patient |
G8758 | All quality actions for the applicable measures in the inflammatory bowel disease (ibd) measures group have been performed for this patient |
G8759 | All quality actions for the applicable measures in the sleep apnea measures group have been performed for this patient |
G8761 | All quality actions for the applicable measures in the dementia measures group have been performed for this patient |
G8762 | All quality actions for the applicable measures in the parkinson's disease measures group have been performed for this patient |
G8763 | All quality actions for the applicable measures in the hypertension (htn) measures group have been performed for this patient |
G8764 | All quality actions for the applicable measures in the cardiovascular prevention measures group have bee performed for this patient |
G8765 | All quality actions for the applicable measures in the cataract measures group have been performed for this patient |
G8767 | Lipid panel results documented and reviewed (must include total cholesterol, hdl-c, triglycerides and calculated ldl-c) |
G8768 | Documentation of medical reason(s) for not performing lipid profile (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) |
G8769 | Lipid profile not performed, reason not given |
G8770 | Urine protein test result documented and reviewed |
G8771 | Documentation of diagnosis of chronic kidney disease |
G8772 | Documentation of medical reason(s) for not performing urine protein test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not cllinically appropriate) |
G8773 | Urine protein test was not performed, reason not given |
G8774 | Serum creatinine test result documented and reviewed |
G8775 | Documentation of medical reason(s) for not performing serum creatinine test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) |
G8776 | Serum creatinine test not performed, reason not given |
G8777 | Diabetes screening test performed |
G8778 | Documentation of medical reason(s) for not performing diabetes screening test (e.g., patients with a diagnosis of diabetes, or with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) |
G8779 | Diabetes screening test not performed, reason not given |
G8780 | Counseling for diet and physical activity performed |
G8781 | Documentation of medical reason(s) for patient not receiving counseling for diet and physical activity (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) |
G8782 | Counseling for diet and physical activity not performed, reason not given |
G8783 | Normal blood pressure reading documented, follow-up not required |
G8784 | Patient not eligible (e.g., documentation the patient is not eligible due to active diagnosis of hypertension, patient refuses, urgent or emergent situation) |
G8785 | Blood pressure reading not documented, reason not given |
G8790 | Most recent office visit systolic blood pressure <130 mm hg |
G8791 | Most recent office visit systolic blood pressure, 130 to 139 mm hg |
G8792 | Most recent office visit systolic blood pressure >=140 mm hg |
G8793 | Most recent office visit diastolic blood pressure, <80 mm hg |
G8794 | Most recent office visit diastolic blood pressure, 80 - 89 mm hg |
G8795 | Most recent office visit diastolic blood pressure >=90 mm hg |
G8796 | Blood pressure measurement not documented, reason not given |
G8797 | Specimen site other than anatomic location of esophagus |
G8798 | Specimen site other than anatomic location of prostate |
G8799 | Anticoagulation ordered |
G8800 | Anticoagulation not ordered for reasons documented by clinician |
G8801 | Anticoagulation was not ordered, reason not given |
G8806 | Performance of trans-abdominal or trans-vaginal ultrasound |
G8807 | Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has visited the ed multiple times within 72 hours, patient has a documented intrauterine pregnancy [iup]) |
G8808 | Performance of trans-abdominal or trans-vaginal ultrasound not ordered, reason not given (e.g., patient has visited the ed multiple times with no documentation of a trans-abdominal or trans-vaginal ultrasound within ed or from referring eligible professional) |
G8809 | Rh-immunoglobulin (rhogam) ordered |
G8810 | Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal) |
G8811 | Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given |
G8812 | Patient is not eligible for follow-up cta, duplex, or mra (e.g., patient death, failure to return for scheduled follow-up exam, planned follow-up study which will meet numerator criteria has not yet occurred at the time of reporting) |
G8813 | Follow-up cta, duplex, or mra of the abdomen and pelvis performed |
G8814 | Follow-up cta, duplex, or mra of the abdomen and pelvis not performed |
G8815 | Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease) |
G8816 | Statin medication prescribed at discharge |
G8817 | Statin therapy not prescribed at discharge, reason not given |
G8818 | Patient discharge to home no later than post-operative day #7 |
G8825 | Patient not discharged to home by post-operative day #7 |
G8826 | Patient discharge to home no later than post-operative day #2 following evar |
G8827 | Aneurysm minor diameter <= 5.5 cm for women |
G8833 | Patient not discharged to home by post-operative day #2 following evar |
G8834 | Patient discharged to home no later than post-operative day #2 following cea |
G8835 | Asymptomatic patient with no history of any transient ischemic attack or stroke in any carotid or vertebrobasilar territory |
G8838 | Patient not discharged to home by post-operative day #2 following cea |
G8839 | Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness |
G8840 | Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy) |
G8841 | Sleep apnea symptoms not assessed, reason not given |
G8842 | Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) measured at the time of initial diagnosis |
G8843 | Documentation of reason(s) for not measuring an apnea hypopnea index (ahi) or a respiratory disturbance index (rdi) at the time of initial diagnosis (e.g., psychiatric disease, dementia, patient declined, financial, insurance coverage, test ordered but not yet completed) |
G8844 | Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) not measured at the time of initial diagnosis, reason not given |
G8845 | Positive airway pressure therapy prescribed |
G8846 | Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater) |
G8848 | Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15) |
G8849 | Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage) |
G8850 | Positive airway pressure therapy not prescribed, reason not given |
G8851 | Objective measurement of adherence to positive airway pressure therapy, documented |
G8852 | Positive airway pressure therapy prescribed |
G8853 | Positive airway pressure therapy not prescribed |
G8854 | Documentation of reason(s) for not objectively measuring adherence to positive airway pressure therapy (e.g., patient didn't bring data from continous positive airway pressure [cpap], therapy not yet initiated, not available on machine) |
G8855 | Objective measurement of adherence to positive airway pressure therapy not performed, reason not given |
G8856 | Referral to a physician for an otologic evaluation performed |
G8857 | Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness) |
G8858 | Referral to a physician for an otologic evaluation not performed, reason not given |
G8859 | Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days |
G8860 | Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days |
G8861 | Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed |
G8862 | Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days |
G8863 | Patients not assessed for risk of bone loss, reason not given |
G8864 | Pneumococcal vaccine administered or previously received |
G8865 | Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction) |
G8866 | Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal) |
G8867 | Pneumococcal vaccine not administered or previously received, reason not given |
G8868 | Patients receiving a first course of anti-tnf therapy |
G8869 | Patient has documented immunity to hepatitis b and is receiving a first course of anti-tnf therapy |
G8870 | Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy |
G8871 | Patient not receiving a first course of anti-tnf therapy |
G8872 | Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion |
G8873 | Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site) |
G8874 | Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion |
G8875 | Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method |
G8876 | Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician) |
G8877 | Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given |
G8878 | Sentinel lymph node biopsy procedure performed |
G8879 | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer |
G8880 | Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, patient refusal after informed consent) |
G8881 | Stage of breast cancer is greater than t1n0m0 or t2n0m0 |
G8882 | Sentinel lymph node biopsy procedure not performed, reason not given |
G8883 | Biopsy results reviewed, communicated, tracked and documented |
G8884 | Clinician documented reason that patient's biopsy results were not reviewed |
G8885 | Biopsy results not reviewed, communicated, tracked or documented |
G8886 | Most recent blood pressure under control |
G8887 | Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) |
G8888 | Most recent blood pressure not under control, results documented and reviewed |
G8889 | No documentation of blood pressure measurement, reason not given |
G8890 | Most recent ldl-c under control, results documented and reviewed |
G8891 | Documentation of medical reason(s) for most recent ldl-c not under control (e.g., patients with palliative goals for for whom treatment of hypertension with standard treatment goals is not clinically appropriate) |
G8892 | Documentation of medical reason(s) for not performing ldl-c test (e.g. patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) |
G8893 | Most recent ldl-c not under control, results documented and reviewed |
G8894 | Ldl-c not performed, reason not given |
G8895 | Oral aspirin or other antithrombotic therapy prescribed |
G8896 | Documentation of medical reason(s) for not prescribing oral aspirin or other antthrombotic therapy (e.g., patient documented to be low risk or patient with terminal illness or treatment of hypertension with standard treatment goals is not clinically appropriate, or for whom risk of aspirin or other antithrombotic therapy exceeds potential benefits such as for individuals whose blood pressure is poorly controlled) |
G8897 | Oral aspirin or other antithrombotic therapy was not prescribed, reason not given |
G8898 | I intend to report the chronic obstructive pulmonary disease (copd) measures group |
G8899 | I intend to report the inflammatory bowel disease (ibd) measures group |
G8900 | I intend to report the sleep apnea measures group |
G8902 | I intend to report the dementia measures group |
G8903 | I intend to report the parkinson's disease measures group |
G8904 | I intend to report the hypertension (htn) measures group |
G8905 | I intend to report the cardiovascular prevention measures group |
G8906 | I intend to report the cataract measures group |
G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility |
G8908 | Patient documented to have received a burn prior to discharge |
G8909 | Patient documented not to have received a burn prior to discharge |
G8910 | Patient documented to have experienced a fall within asc |
G8911 | Patient documented not to have experienced a fall within ambulatory surgical center |
G8912 | Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event |
G8913 | Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event |
G8914 | Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc |
G8915 | Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc |
G8916 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time |
G8917 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time |
G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis |
G8919 | Most recent systolic blood pressure < 140 mmhg |
G8920 | Most recent systolic blood pressure >= 140 mmhg |
G8921 | Most recent diastolic blood pressure < 90 mmhg |
G8922 | Most recent diastolic blood pressure >= 90 mmhg |
G8923 | Left ventricular ejection fraction (lvef) < 40% or documentation of moderately or severely depressed left ventricular systolic function |
G8924 | Spirometry test results demonstrate fev1/fvc < 70%, fev < 60% predicted and patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing) |
G8925 | Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or patient does not have copd symptoms |
G8926 | Spirometry test not performed or documented, reason not given |
G8927 | Adjuvant chemotherapy referred, prescribed or previously received for ajcc stage iii, colon cancer |
G8928 | Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons) |
G8929 | Adjuvant chemotherapy not prescribed or previously received, reason not given |
G8930 | Assessment of depression severity at the initial evaluation |
G8931 | Assessment of depression severity not documented, reason not given |
G8932 | Suicide risk assessed at the initial evaluation |
G8933 | Suicide risk not assessed at the initial evaluation, reason not given |
G8934 | Left ventricular ejection fraction (lvef) <40% or documentation of moderately or severely depressed left ventricular systolic function |
G8935 | Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy |
G8936 | Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons) or (eg, lack of drug availability, other reasons attributable to the health care system) |
G8937 | Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given |
G8938 | Bmi is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible |
G8939 | Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible |
G8940 | Screening for depression documented as positive, a follow-up plan not completed, documented reason |
G8941 | Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible |
G8942 | Functional outcomes assessment using a standardized tool is documented within the previous 30 days and care plan, based on identified deficiencies on the date of the functional outcome assessment, is documented |
G8943 | Ldl-c result not present or not within 12 months prior |
G8944 | Ajcc melanoma cancer stage 0 through iic melanoma |
G8945 | Aneurysm minor diameter <= 6 cm for men |
G8946 | Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells) |
G8947 | One or more neuropsychiatric symptoms |
G8948 | No neuropsychiatric symptoms |
G8949 | Documentation of patient reason(s) for patient not receiving counseling for diet and physical activity (e.g., patient is not willing to discuss diet or exercise interventions to help control blood pressure, or the patient said he/she refused to make these changes) |
G8950 | Pre-hypertensive or hypertensive blood pressure reading documented, and the indicated follow-up is documented |
G8951 | Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible |
G8952 | Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given |
G8953 | All quality actions for the applicable measures in the oncology measures group have been performed for this patient |
G8954 | Complete and appropriate patient data were reported to a qualified clinical database registry |
G8955 | Most recent assessment of adequacy of volume management documented |
G8956 | Patient receiving maintenance hemodialysis in an outpatient dialysis facility |
G8957 | Patient not receiving maintenance hemodialysis in an outpatient dialysis facility |
G8958 | Assessment of adequacy of volume management not documented, reason not given |
G8959 | Clinician treating major depressive disorder communicates to clinician treating comorbid condition |
G8960 | Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not given |
G8961 | Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery |
G8962 | Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery |
G8963 | Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 years |
G8964 | Cardiac stress imaging test performed primarily for any other reason than monitoring of asymptomatic patient who had pci within 2 years (e.g., symptomatic patient, patient greater than 2 years since pci, initial evaluation, etc) |
G8965 | Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessment |
G8966 | Cardiac stress imaging test performed on symptomatic or higher than low chd risk patient or for any reason other than initial detection and risk assessment |
G8967 | Warfarin or another oral anticoagulant that is fda approved prescribed |
G8968 | Documentation of medical reason(s) for not prescribing warfarin or another oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., allergy, risk of bleeding, other medical reasons) |
G8969 | Documentation of patient reason(s) for not prescribing warfarin or another oral anticoagulant that is fda approved (e.g., economic, social, and/or religious impediments, noncompliance patient refusal, other patient reasons) |
G8970 | No risk factors or one moderate risk factor for thromboembolism |
G8971 | Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not given |
G8972 | One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolism |
G8973 | Most recent hemoglobin (hgb) level < 10 g/dl |
G8974 | Hemoglobin level measurement not documented, reason not given |
G8975 | Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons) |
G8976 | Most recent hemoglobin (hgb) level >= 10 g/dl |
G8977 | I intend to report the oncology measures group |
G8978 | Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
G8979 | Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G8980 | Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
G8981 | Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals |
G8982 | Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G8983 | Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting |
G8984 | Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals |
G8985 | Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G8986 | Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting |
G8987 | Self care functional limitation, current status, at therapy episode outset and at reporting intervals |
G8988 | Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G8989 | Self care functional limitation, discharge status, at discharge from therapy or to end reporting |
G8990 | Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals |
G8991 | Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G8992 | Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting |
G8993 | Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals |
G8994 | Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G8995 | Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting |
G8996 | Swallowing functional limitation, current status at therapy episode outset and at reporting intervals |
G8997 | Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G8998 | Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting |
G8999 | Motor speech functional limitation, current status at therapy episode outset and at reporting intervals |
G9001 | Coordinated care fee, initial rate |
G9002 | Coordinated care fee, maintenance rate |
G9003 | Coordinated care fee, risk adjusted high, initial |
G9004 | Coordinated care fee, risk adjusted low, initial |
G9005 | Coordinated care fee, risk adjusted maintenance |
G9006 | Coordinated care fee, home monitoring |
G9007 | Coordinated care fee, scheduled team conference |
G9008 | Coordinated care fee, physician coordinated care oversight services |
G9009 | Coordinated care fee, risk adjusted maintenance, level 3 |
G9010 | Coordinated care fee, risk adjusted maintenance, level 4 |
G9011 | Coordinated care fee, risk adjusted maintenance, level 5 |
G9012 | Other specified case management service not elsewhere classified |
G9013 | Esrd demo basic bundle level i |
G9014 | Esrd demo expanded bundle including venous access and related services |
G9016 | Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only] |
G9017 | Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project) |
G9018 | Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project) |
G9019 | Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project) |
G9020 | Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project) |
G9033 | Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project) |
G9034 | Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project) |
G9035 | Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project) |
G9036 | Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project) |
G9050 | Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project) |
G9051 | Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project) |
G9052 | Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project) |
G9053 | Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project) |
G9054 | Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project) |
G9055 | Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project) |
G9056 | Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project) |
G9057 | Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project) |
G9058 | Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project) |
G9059 | Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project) |
G9060 | Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project) |
G9061 | Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project) |
G9062 | Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project) |
G9063 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9064 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9065 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9066 | Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
G9067 | Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9068 | Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9069 | Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
G9070 | Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9071 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9072 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9073 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9074 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9075 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
G9077 | Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9078 | Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9079 | Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9080 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project) |
G9083 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9084 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9085 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9086 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9087 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project) |
G9088 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project) |
G9089 | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9090 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9091 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9092 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project) |
G9093 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9094 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
G9095 | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9096 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9097 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9098 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
G9099 | Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9100 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project) |
G9101 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) |
G9102 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) |
G9103 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
G9104 | Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9105 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9106 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project) |
G9107 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
G9108 | Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9109 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9110 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9111 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project) |
G9112 | Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9113 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9114 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9115 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project) |
G9116 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project) |
G9117 | Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9123 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
G9124 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
G9125 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
G9126 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project) |
G9128 | Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project) |
G9129 | Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project) |
G9130 | Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9131 | Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project) |
G9132 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project) |
G9133 | Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project) |
G9134 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project) |
G9135 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project) |
G9136 | Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project) |
G9137 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project) |
G9138 | Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project) |
G9139 | Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project) |
G9140 | Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours |
G9143 | Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s) |
G9147 | Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration |
G9148 | National committee for quality assurance - level 1 medical home |
G9149 | National committee for quality assurance - level 2 medical home |
G9150 | National committee for quality assurance - level 3 medical home |
G9151 | Mapcp demonstration - state provided services |
G9152 | Mapcp demonstration - community health teams |
G9153 | Mapcp demonstration - physician incentive pool |
G9156 | Evaluation for wheelchair requiring face to face visit with physician |
G9157 | Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes |
G9158 | Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting |
G9159 | Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals |
G9160 | Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G9161 | Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting |
G9162 | Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals |
G9163 | Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G9164 | Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting |
G9165 | Attention functional limitation, current status at therapy episode outset and at reporting intervals |
G9166 | Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G9167 | Attention functional limitation, discharge status at discharge from therapy or to end reporting |
G9168 | Memory functional limitation, current status at therapy episode outset and at reporting intervals |
G9169 | Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G9170 | Memory functional limitation, discharge status at discharge from therapy or to end reporting |
G9171 | Voice functional limitation, current status at therapy episode outset and at reporting intervals |
G9172 | Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G9173 | Voice functional limitation, discharge status at discharge from therapy or to end reporting |
G9174 | Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals |
G9175 | Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G9176 | Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting |
G9186 | Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
G9187 | Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code |
G9188 | Beta-blocker therapy not prescribed, reason not given |
G9189 | Beta-blocker therapy prescribed or currently being taken |
G9190 | Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons) |
G9191 | Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) |
G9192 | Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system) |
G9193 | Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression |
G9194 | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase |
G9195 | Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase |
G9196 | Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s)) |
G9197 | Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis |
G9198 | Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given |
G9199 | Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s)) |
G9200 | Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given |
G9201 | Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission |
G9202 | Patients with a positive hepatitis c antibody test |
G9203 | Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c |
G9204 | Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given |
G9205 | Patient starting antiviral treatmentfor hepatitis c during the measurement period |
G9206 | Patient starting antiviral treatment for hepatitis c during the measurement period |
G9207 | Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c |
G9208 | Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given |
G9209 | Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment |
G9210 | Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons) |
G9211 | Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given |
G9212 | Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation |
G9213 | Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified |
G9214 | Cd4+ cell count or cd4+ cell percentage results documented |
G9215 | Cd4+ cell count or percentage not documented as performed, reason not given |
G9216 | Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given |
G9217 | Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given |
G9218 | Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given |
G9219 | Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) |
G9220 | Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) |
G9221 | Pneumocystis jiroveci pneumonia prophlaxis prescribed |
G9222 | Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3 |
G9223 | Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% |
G9224 | Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation) |
G9225 | Foot exam was not performed, reason not given |
G9226 | Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed) |
G9227 | Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan |
G9228 | Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) |
G9229 | Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception) |
G9230 | Chlamydia, gonorrhea, and syphilis not screened, reason not given |
G9231 | Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period |
G9232 | Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason (e.g., patient is unable to communicate the diagnosis of a comorbid condition; the patient is unwilling to communicate the diagnosis of a comorbid condition; or the patient is unaware of the comorbid condition, or any other specified patient reason) |
G9233 | All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient |
G9234 | I intend to report the total knee replacement measures group |
G9235 | All quality actions for the applicable measures in the general surgery measures group have been performed for this patient |
G9236 | All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient |
G9237 | I intend to report the general surgery measures group |
G9238 | I intend to report the optimizing patient exposure to ionizing radiation measures group |
G9239 | Documentation of reasons for patient initiaiting maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing avf/avg, time-limited trial of hemodialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons) |
G9240 | Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated |
G9241 | Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated |
G9242 | Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed |
G9243 | Documentation of viral load less than 200 copies/ml |
G9244 | Antiretroviral thereapy not prescribed |
G9245 | Antiretroviral therapy prescribed |
G9246 | Patient did not have at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits |
G9247 | Patient had at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits |
G9248 | Patient did not have a medical visit in the last 6 months |
G9249 | Patient had a medical visit in the last 6 months |
G9250 | Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment |
G9251 | Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment |
G9252 | Adenoma(s) or other neoplasm detected during screening colonoscopy |
G9253 | Adenoma(s) or other neoplasm not detected during screening colonoscopy |
G9254 | Documentation of patient discharged to home later than post-operative day 2 following cas |
G9255 | Documentation of patient discharged to home no later than post operative day 2 following cas |
G9256 | Documentation of patient death following cas |
G9257 | Documentation of patient stroke following cas |
G9258 | Documentation of patient stroke following cea |
G9259 | Documentation of patient survival and absence of stroke following cas |
G9260 | Documentation of patient death following cea |
G9261 | Documentation of patient survival and absence of stroke following cea |
G9262 | Documentation of patient death in the hospital following endovascular aaa repair |
G9263 | Documentation of patient survival in the hospital following endovascular aaa repair |
G9264 | Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined avf/avg, other patient reasons) |
G9265 | Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access |
G9266 | Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access |
G9267 | Documentation of patient with one or more complications or mortality within 30 days |
G9268 | Documentation of patient with one or more complications within 90 days |
G9269 | Documentation of patient without one or more complications and without mortality within 30 days |
G9270 | Documentation of patient without one or more complications within 90 days |
G9271 | Ldl value < 100 |
G9272 | Ldl value >= 100 |
G9273 | Blood pressure has a systolic value of < 140 and a diastolic value of < 90 |
G9274 | Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90 |
G9275 | Documentation that patient is a current non-tobacco user |
G9276 | Documentation that patient is a current tobacco user |
G9277 | Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux) |
G9278 | Documentation that the patient is not on daily aspirin or anti-platelet regimen |
G9279 | Pneumococcal screening performed and documentation of vaccination received prior to discharge |
G9280 | Pneumococcal vaccination not administered prior to discharge, reason not specified |
G9281 | Screening performed and documentation that vaccination not indicated/patient refusal |
G9282 | Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons) |
G9283 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation |
G9284 | Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation |
G9285 | Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer |
G9286 | Antibiotic regimen prescribed within 10 days after onset of symptoms |
G9287 | Antibiotic regimen not prescribed within 10 days after onset of symptoms |
G9288 | Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons) |
G9289 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation |
G9290 | Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation |
G9291 | Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos |
G9292 | Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons) |
G9293 | Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
G9294 | Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
G9295 | Specimen site other than anatomic cutaneous location |
G9296 | Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure |
G9297 | Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure, not documented, reason not given |
G9298 | Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke) |
G9299 | Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure including (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given) |
G9300 | Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used) |
G9301 | Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet |
G9302 | Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given |
G9303 | Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant, reason not given |
G9304 | Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant |
G9305 | Intervention for presence of leak of endoluminal contents through an anastomosis not required |
G9306 | Intervention for presence of leak of endoluminal contents through an anastomosis required |
G9307 | No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure |
G9308 | Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure |
G9309 | No unplanned hospital readmission within 30 days of principal procedure |
G9310 | Unplanned hospital readmission within 30 days of principal procedure |
G9311 | No surgical site infection |
G9312 | Surgical site infection |
G9313 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason (eg, cystic fibrosis, immotile cilia disorders, ciliary dyskinesia, immune deficiency, prior history of sinus surgery within the past 12 months, and anatomic abnormalities, such as deviated nasal septum, resistant organisms, allergy to medication, recurrent sinusitis, chronic sinusitis, or other reasons) |
G9314 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given |
G9315 | Documentation amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis |
G9316 | Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family |
G9317 | Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed |
G9318 | Imaging study named according to standardized nomenclature |
G9319 | Imaging study not named according to standardized nomenclature, reason not given |
G9320 | Documentation of medical reason(s) for not naming ct studies according to a standardized nomenclature provided (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
G9321 | Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion) studies documented in the 12-month period prior to the current study |
G9322 | Count of previous ct and cardiac nuclear medicine (myocardial perfusion) studies not documented in the 12-month period prior to the current study, reason not given |
G9323 | Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
G9324 | All necessary data elements not included, reason not given |
G9325 | Ct studies not reported to a radiation dose index registry due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
G9326 | Ct studies performed not reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements, reason not given |
G9327 | Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements |
G9328 | Dicom format image data availability not documented in final report due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
G9329 | Dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given |
G9340 | Final report documented that dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study |
G9341 | Search conducted for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed |
G9342 | Search not conducted prior to an imaging study being performed for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive, reason not given |
G9343 | Due to medical reasons, search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
G9344 | Due to system reasons search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., non-affiliated external healthcare facilities or entities does not have archival abilities through a shared archival system) |
G9345 | Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors |
G9346 | Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
G9347 | Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given |
G9348 | Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons (eg, persons with sinusitis symptoms lasting at least 7 to 10 days, antibiotic resistance, immunocompromised, recurrent sinusitis, acute frontal sinusitis, acute sphenoid sinusitis, periorbital cellulitis, or other medical) |
G9349 | Documentation of a ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis |
G9350 | Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis |
G9351 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis |
G9352 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given |
G9353 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with complications, second ct obtained prior to surgery, other medical reasons) |
G9354 | One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis |
G9355 | Elective delivery or early induction not performed |
G9356 | Elective delivery or early induction performed |
G9357 | Post-partum screenings, evaluations and education performed |
G9358 | Post-partum screenings, evaluations and education not performed |
G9359 | Documentation of negative or managed positive tb screen with further evidence that tb is not active within one year of patient visit |
G9360 | No documentation of negative or managed positive tb screen |
G9361 | Medical indication for induction [documentation of reason(s) for elective delivery (c-section) or early induction (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes-premature or prolonged, maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)] |
G9362 | Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record |
G9363 | Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record |
G9364 | Sinusitis caused by, or presumed to be caused by, bacterial infection |
G9365 | One high-risk medication ordered |
G9366 | One high-risk medication not ordered |
G9367 | At least two different high-risk medications ordered |
G9368 | At least two different high-risk medications not ordered |
G9369 | Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater |
G9370 | Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater |
G9376 | Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery |
G9377 | Patient did not have the retina attached after 6 months following only one surgery |
G9378 | Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) |
G9379 | Patient did not achieve flat retinas six months post surgery |
G9380 | Patient offered assistance with end of life issues during the measurement period |
G9381 | Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period |
G9382 | Patient not offered assistance with end of life issues during the measurement period |
G9383 | Patient received screening for hcv infection within the 12 month reporting period |
G9384 | Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons) |
G9385 | Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons) |
G9386 | Screening for hcv infection not received within the 12 month reporting period, reason not given |
G9389 | Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery |
G9390 | No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery |
G9391 | Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit |
G9392 | Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit |
G9393 | Patient with an initial phq-9 score greater than nine who achieves remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of less than five |
G9394 | Patient who had a diagnosis of bipolar disorder or personality disorder, death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement or assessment period |
G9395 | Patient with an initial phq-9 score greater than nine who did not achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score greater than or equal to five |
G9396 | Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days) |
G9399 | Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment |
G9400 | Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons |
G9401 | No documentation of a discussion in the patient record of a discussion between the physician or other qualfied healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment |
G9402 | Patient received follow-up on the date of discharge or within 30 days after discharge |
G9403 | Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up) |
G9404 | Patient did not receive follow-up on the date of discharge or within 30 days after discharge |
G9405 | Patient received follow-up within 7 days from discharge |
G9406 | Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up) |
G9407 | Patient did not receive follow-up on or within 7 days after discharge |
G9408 | Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days |
G9409 | Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days |
G9410 | Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
G9411 | Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
G9412 | Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
G9413 | Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision |
G9414 | Patient had one dose of meningococcal vaccine on or between the patient's 11th and 13th birthdays |
G9415 | Patient did not have one dose of meningococcal vaccine on or between the patient's 11th and 13th birthdays |
G9416 | Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays |
G9417 | Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays |
G9418 | Primary non-small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation |
G9419 | Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of primary non-small cell lung cancer or other documented medical reasons) |
G9420 | Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer |
G9421 | Primary non-small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation |
G9422 | Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (squamous cell carcinoma, adenocarcinoma and not nsclc-nos) |
G9423 | Documentation of medical reason for not including pt category, pn category and histologic type [for patient with appropriate exclusion criteria (e.g., metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)] |
G9424 | Specimen site other than anatomic location of lung, or classified as nsclc-nos |
G9425 | Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (squamous cell carcinoma, adenocarcinoma) |
G9426 | Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients |
G9427 | Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients |
G9428 | Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
G9429 | Documentation of medical reason(s) for not including 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) |
G9430 | Specimen site other than anatomic cutaneous location |
G9431 | Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
G9432 | Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented |
G9433 | Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period |
G9434 | Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given |
G9435 | Aspirin prescribed at discharge |
G9436 | Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) |
G9437 | Aspirin not prescribed at discharge |
G9438 | P2y inhibitor prescribed at discharge |
G9439 | P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed) |
G9440 | P2y inhibitor not prescribed at discharge |
G9441 | Statin prescribed at discharge |
G9442 | Statin not prescribed for documented reasons (e.g., allergy, medical intolerance) |
G9443 | Statin not prescribed at discharge |
G9448 | Patients who were born in the years 1945?1965 |
G9449 | History of receiving blood transfusions prior to 1992 |
G9450 | History of injection drug use |
G9451 | Patient received one-time screening for hcv infection |
G9452 | Documentation of medical reason(s) for not receiving one-time screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [ie, ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons) |
G9453 | Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons) |
G9454 | One-time screening for hcv infection not received within 12 month reporting period and no documentation of prior screening for hcv infection, reason not given |
G9455 | Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc |
G9456 | Documentation of medical or patient reason(s) for not ordering or performing screening for hcc. medical reason: comorbid medical conditions with expected survival < 5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons; patient reasons: patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment) |
G9457 | Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the reporting period |
G9458 | Patient documented as tobacco user and received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user |
G9459 | Currently a tobacco non-user |
G9460 | Tobacco assessment or tobacco cessation intervention not performed, reason not given |
G9463 | I intend to report the sinusitis measures group |
G9464 | All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient |
G9465 | I intend to report the acute otitis externa (aoe) measures group |
G9466 | All quality actions for the applicable measures in the aoe measures group have been performed for this patient |
G9467 | Patient who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills within the last twelve months |
G9468 | Patient not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills |
G9469 | Patients who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills |
G9470 | Patients not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills |
G9471 | Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented |
G9472 | Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered and documented, no review of systems and no medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed |
G9473 | Services performed by chaplain in the hospice setting, each 15 minutes |
G9474 | Services performed by dietary counselor in the hospice setting, each 15 minutes |
G9475 | Services performed by other counselor in the hospice setting, each 15 minutes |
G9476 | Services performed by volunteer in the hospice setting, each 15 minutes |
G9477 | Services performed by care coordinator in the hospice setting, each 15 minutes |
G9478 | Services performed by other qualified therapist in the hospice setting, each 15 minutes |
G9479 | Services performed by qualified pharmacist in the hospice setting, each 15 minutes |
G9480 | Admission to medicare care choice model program (mccm) |
G9481 | Remote in-home visit for the evaluation and management of a new patient for use only in the medicare-approved comprehensive care for joint replacement model, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
G9482 | Remote in-home visit for the evaluation and management of a new patient for use only in the medicare-approved comprehensive care for joint replacement model, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
G9483 | Remote in-home visit for the evaluation and management of a new patient for use only in the medicare-approved comprehensive care for joint replacement model, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
G9484 | Remote in-home visit for the evaluation and management of a new patient for use only in the medicare-approved comprehensive care for joint replacement model, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
G9485 | Remote in-home visit for the evaluation and management of a new patient for use only in the medicare-approved comprehensive care for joint replacement model, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
G9486 | Remote in-home visit for the evaluation and management of an established patient for use only in the medicare-approved comprehensive care for joint replacement model, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
G9487 | Remote in-home visit for the evaluation and management of an established patient for use only in the medicare-approved comprehensive care for joint replacement model, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
G9488 | Remote in-home visit for the evaluation and management of an established patient for use only in the medicare-approved comprehensive care for joint replacement model, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology |
G9489 | Remote in-home visit for the evaluation and management of an established patient for use only in the medicare-approved comprehensive care for joint replacement model, 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 | Comprehensive care for joint replacement model, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in the medicare-approved cjr model); may not be billed for a 30 day period covered by a transitional care management code |
G9496 | Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma |
G9497 | Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery |
G9498 | Antibiotic regimen prescribed |
G9499 | Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period |
G9500 | Radiation exposure indices, or exposure time and number of fluorographic images in final report for procedures using fluoroscopy, documented |
G9501 | Radiation exposure indices, or exposure time and number of fluorographic images not documented in final report for procedure using fluoroscopy, reason not given |
G9502 | Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period) |
G9503 | Patient taking tamsulosin hydrochloride |
G9504 | Documented reason for not assessing hepatitis b virus (hbv) status (e.g. patient not receiving a first course of anti-tnf therapy, patient declined) within one year prior to first course of anti-tnf therapy |
G9505 | Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason |
G9506 | Biologic immune response modifier prescribed |
G9507 | Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs) |
G9508 | Documentation that the patient is not on a statin medication |
G9509 | Remission at twelve months as demonstrated by a twelve month (+/-30 days) phq-9 score of less than 5 |
G9510 | Remission at twelve months not demonstrated by a twelve month (+/-30 days) phq-9 score of less than five; either phq-9 score was not assessed or is greater than or equal to 5 |
G9511 | Index date phq-9 score greater than 9 documented during the twelve month denominator identification period |
G9512 | Individual had a pdc of 0.8 or greater |
G9513 | Individual did not have a pdc of 0.8 or greater |
G9514 | Patient required a return to the operating room within 90 days of surgery |
G9515 | Patient did not require a return to the operating room within 90 days of surgery |
G9516 | Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery |
G9517 | Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given |
G9518 | Documentation of active injection drug use |
G9519 | Patient achieves final refraction (spherical equivalent) +/- 0.5 diopters of their planned refraction within 90 days of surgery |
G9520 | Patient does not achieve final refraction (spherical equivalent) +/- 0.5 diopters of their planned refraction within 90 days of surgery |
G9521 | Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months |
G9522 | Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given |
G9523 | Patient discontinued from hemodialysis or peritoneal dialysis |
G9524 | Patient was referred to hospice care |
G9525 | Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons) |
G9526 | Patient was not referred to hospice care, reason not given |
G9529 | Patient with minor blunt head trauma had an appropriate indication(s) for a head ct |
G9530 | Patient presented within 24 hours of a minor blunt head trauma with a gcs score of 15 and had a head ct ordered for trauma by an emergency care provider |
G9531 | Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, pregnancy, or is currently taking an antiplatelet medication including: asa/dipyridamole, clopidogrel, prasugrel, ticlopidine, ticagrelor or cilstazol) |
G9532 | Patient's head injury occurred greater than 24 hours before presentation to the emergency department, or has a gcs score less than 15 or does not have a gcs score documented, or had a head ct for trauma ordered by someone other than an emergency care provider, or was ordered for a reason other than trauma |
G9533 | Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct |
G9534 | Advanced brain imaging (cta, ct, mra or mri) was not ordered |
G9535 | Patients with a normal neurological examination |
G9536 | Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms) |
G9537 | Documentation of system reason(s) for ordering an advanced brain imaging study (i.e., needed as part of a clinical trial; other clinician ordered the study) |
G9538 | Advanced brain imaging (cta, ct, mra or mri) was ordered |
G9539 | Intent for potential removal at time of placement |
G9540 | Patient alive 3 months post procedure |
G9541 | Filter removed within 3 months of placement |
G9542 | Documented re-assessment for the appropriateness of filter removal within 3 months of placement |
G9543 | Documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement |
G9544 | Patients that do not have the filter removed, documented re-assessment for the appropriateness of filter removal, or documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement |
G9547 | Incidental finding: liver lesion <= 0.5 cm, cystic kidney lesion < 1.0 cm or adrenal lesion <= 1.0 cm |
G9548 | Final reports for abdominal imaging studies with follow-up imaging recommended |
G9549 | Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has a known malignancy that can metastasize, other medical reason(s) such as fever in an immunocompromised patient) |
G9550 | Final reports for abdominal imaging studies with follow-up imaging not recommended |
G9551 | Final reports for abdominal imaging studies without an incidentally found lesion noted: liver lesion <= 0.5 cm, cystic kidney lesion < 1.0 cm or adrenal lesion <= 1.0 cm noted or no lesion found |
G9552 | Incidental thyroid nodule < 1.0 cm noted in report |
G9553 | Prior thyroid disease diagnosis |
G9554 | Final reports for ct, cta, mri or mra of the chest or neck or ultrasound of the neck with follow-up imaging recommended |
G9555 | Documentation of medical reason(s) for recommending follow up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s)) |
G9556 | Final reports for ct, cta, mri or mra of the chest or neck or ultrasound of the neck with follow-up imaging not recommended |
G9557 | Final reports for ct, cta, mri or mra studies of the chest or neck or ultrasound of the neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found |
G9558 | Patient treated with a beta-lactam antibiotic as definitive therapy |
G9559 | Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics) |
G9560 | Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given |
G9561 | Patients prescribed opiates for longer than six weeks |
G9562 | Patients who had a follow-up evaluation conducted at least every three months during opioid therapy |
G9563 | Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy |
G9572 | Index date phq-score greater than 9 documented during the twelve month denominator identification period |
G9573 | Remission at six months as demonstrated by a six month (+/-30 days) phq-9 score of less than five |
G9574 | Remission at six months not demonstrated by a six month (+/-30 days) phq-9 score of less than five; either phq-9 score was not assessed or is greater than or equal to five |
G9577 | Patients prescribed opiates for longer than six weeks |
G9578 | Documentation of signed opioid treatment agreement at least once during opioid therapy |
G9579 | No documentation of signed an opioid treatment agreement at least once during opioid therapy |
G9580 | Door to puncture time of less than 2 hours |
G9581 | Door to puncture time of greater than 2 hours for reasons documented by clinician (e.g., patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment; hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment) |
G9582 | Door to puncture time of greater than 2 hours, no reason given |
G9583 | Patients prescribed opiates for longer than six weeks |
G9584 | Patient evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least once during opioid therapy |
G9585 | Patient not evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at least once during opioid therapy |
G9593 | Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules |
G9594 | Patient presented within 24 hours of a minor blunt head trauma with a gcs score of 15 and had a head ct ordered for trauma by an emergency care provider |
G9595 | Patient has documentation of ventricular shunt, brain tumor, coagulopathy, including thrombocytopenia |
G9596 | Pediatric patient's head injury occurred greater than 24 hours before presentation to the emergency department, or has a gcs score less than 15 or does not have a gcs score documented, or had a head ct for trauma ordered by someone other than an emergency care provider, or was ordered for a reason other than trauma |
G9597 | Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules |
G9598 | Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct |
G9599 | Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct |
G9600 | Symptomatic aaas that required urgent/emergent (non-elective) repair |
G9601 | Patient discharge to home no later than post-operative day #7 |
G9602 | Patient not discharged to home by post-operative day #7 |
G9603 | Patient survey score improved from baseline following treatment |
G9604 | Patient survey results not available |
G9605 | Patient survey score did not improve from baseline following treatment |
G9606 | Intraoperative cystoscopy performed to evaluate for lower tract injury |
G9607 | Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) |
G9608 | Intraoperative cystoscopy not performed to evaluate for lower tract injury |
G9609 | Documentation of an order for anti-platelet agents |
G9610 | Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents |
G9611 | Order for anti-platelet agents was not documented in the patient's record, reason not given |
G9612 | Photodocumentation of one or more cecal landmarks to establish a complete examination |
G9613 | Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.) |
G9614 | No photodocumentation of cecal landmarks to establish a complete examination |
G9615 | Preoperative assessment documented |
G9616 | Documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery) |
G9617 | Preoperative assessment not documented, reason not given |
G9618 | Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind |
G9619 | Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy) |
G9620 | Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given |
G9621 | Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling |
G9622 | Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method |
G9623 | Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons) |
G9624 | Patient not screened for unhealthy alcohol screening using a systematic screening method or patient did not receive brief counseling, reason not given |
G9625 | Patient sustained bladder injury at the time of surgery or discovered subsequently up to 1 month post-surgery |
G9626 | Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury) |
G9627 | Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 1 month post-surgery |
G9628 | Patient sustained bowel injury at the time of surgery or discovered subsequently up to 1 month post-surgery |
G9629 | Documented medical reasons for not reporting bowel injury (e.g., gynecologic or other pelvic malignancy documented, planned (e.g., not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury) |
G9630 | Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 1 month post-surgery |
G9631 | Patient sustained ureter injury at the time of surgery or discovered subsequently up to 1 month post-surgery |
G9632 | Documented medical reasons for not reporting ureter injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of ureter injury) |
G9633 | Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 1 month post-surgery |
G9634 | Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved |
G9635 | Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the hrqol survey, patient has the inability to read and/or write in order to complete the hrqol questionnaire) |
G9636 | Health-related quality of life not assessed with tool during at least two visits or quality of life score declined |
G9637 | Final reports with documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique) |
G9638 | Final reports without documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique) |
G9639 | Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure |
G9640 | Documentation of planned hybrid or staged procedure |
G9641 | Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure |
G9642 | Current smokers (e.g., cigarette, cigar, pipe, e-cigarette or marijuana) |
G9643 | Elective surgery |
G9644 | Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure |
G9645 | Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure |
G9646 | Patients with 90 day mrs score of 0 to 2 |
G9647 | Patients in whom mrs score could not be obtained at 90 day follow-up |
G9648 | Patients with 90 day mrs score greater than 2 |
G9649 | Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) |
G9650 | Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi |
G9651 | Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) or psoriasis assessment tool not documented |
G9652 | Patient has been treated with a systemic or biologic medication for psoriasis for at least six months |
G9653 | Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months |
G9654 | Monitored anesthesia care (mac) |
G9655 | A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used |
G9656 | Patient transferred directly from anesthetizing location to pacu |
G9657 | Transfer of care during an anesthetic or to the intensive care unit |
G9658 | A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used |
G9659 | Patients greater than 85 years of age who did not have a history of colorectal cancer or valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits |
G9660 | Documentation of medical reason(s) for a colonoscopy performed on a patient greater than 85 years of age (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, iron deficiency anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional enteritis), familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits) |
G9661 | Patients greater than 85 years of age who received a routine colonoscopy for a reason other than the following: an assessment of signs/symptoms of gi tract illness, and/or the patient is considered high risk, and/or to follow-up on previously diagnosed advance lesions |
G9662 | Previously diagnosed or have an active diagnosis of clinical ascvd |
G9663 | Any fasting or direct ldl-c laboratory test result = 190 mg/dl |
G9664 | Patients who are currently statin therapy users or received an order (prescription) for statin therapy |
G9665 | Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy |
G9666 | The highest fasting or direct ldl-c laboratory test result of 70-189 mg/dl in the measurement period or two years prior to the beginning of the measurement period |
G9667 | Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy) |
G9669 | I intend to report the multiple chronic conditions measures group |
G9670 | All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient |
G9671 | I intend to report the diabetic retinopathy measures group |
G9672 | All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient |
G9673 | I intend to report the cardiovascular prevention measures group |
G9674 | Patients with clinical ascvd diagnosis |
G9675 | Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl |
G9676 | Patients aged 40 to 75 years at the beginning of the measurement period with type 1 or type 2 diabetes and with an ldl-c result of 70?189 mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period |
G9677 | All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient |
G9678 | Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation agreement |
G9679 | This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary |
G9680 | This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary |
G9681 | This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary |
G9682 | This code is for the onsite acute care treatment a nursing facility resident with a skin infection; may only be billed once per day per beneficiary |
G9683 | This code is for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder or dehydration (similar pattern); may only be billed once per day per beneficiary |
G9684 | This code is for the onsite acute care treatment of a nursing facility resident for a uti; may only be billed once per day per beneficiary |
G9685 | This code is for the evaluation and management of a beneficiary's acute change in condition in a nursing facility |
G9686 | Onsite nursing facility conference, that is separate and distinct from an evaluation and management visit, including qualified practitioner and at least one member of the nursing facility interdisciplinary care team |
G9687 | Hospice services provided to patient any time during the measurement period |
G9688 | Patients using hospice services any time during the measurement period |
G9689 | Patient admitted for performance of elective carotid intervention |
G9690 | Patient receiving hospice services any time during the measurement period |
G9691 | Patient had hospice services any time during the measurement period |
G9692 | Hospice services received by patient any time during the measurement period |
G9693 | Patient use of hospice services any time during the measurement period |
G9694 | Hospice services utilized by patient any time during the measurement period |
G9695 | Long-acting inhaled bronchodilator prescribed |
G9696 | Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator |
G9697 | Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator |
G9698 | Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator |
G9699 | Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified |
G9700 | Patients who use hospice services any time during the measurement period |
G9701 | Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established |
G9702 | Patients who use hospice services any time during the measurement period |
G9703 | Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis |
G9704 | Ajcc breast cancer stage i: t1 mic or t1a documented |
G9705 | Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented |
G9706 | Low (or very low) risk of recurrence, prostate cancer |
G9707 | Patient received hospice services any time during the measurement period |
G9708 | Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy |
G9709 | Hospice services used by patient any time during the measurement period |
G9710 | Patient was provided hospice services any time during the measurement period |
G9711 | Patients with a diagnosis or past history of total colectomy or colorectal cancer |
G9712 | Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis |
G9713 | Patients who use hospice services any time during the measurement period |
G9714 | Patient is using hospice services any time during the measurement period |
G9715 | Patients who use hospice services any time during the measurement period |
G9716 | Bmi is documented as being outside of normal limits, follow-up plan is not completed for documented reason |
G9717 | Documentation stating the patient has an active diagnosis of depression or has a diagnosed bipolar disorder, therefore screening or follow-up not required |
G9718 | Hospice services for patient provided any time during the measurement period |
G9719 | Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair |
G9720 | Hospice services for patient occurred any time during the measurement period |
G9721 | Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair |
G9722 | Documented history of renal failure or baseline serum creatinine = 4.0 mg/dl; renal transplant recipients are not considered to have preoperative renal failure, unless, since transplantation the cr has been or is 4.0 or higher |
G9723 | Hospice services for patient received any time during the measurement period |
G9724 | Patients who had documentation of use of anticoagulant medications overlapping the measurement year |
G9725 | Patients who use hospice services any time during the measurement period |
G9726 | Patient refused to participate |
G9727 | Patient unable to complete the foto knee intake prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
G9728 | Patient refused to participate |
G9729 | Patient unable to complete the foto hip intake prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
G9730 | Patient refused to participate |
G9731 | Patient unable to complete the foto foot or ankle intake prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
G9732 | Patient refused to participate |
G9733 | Patient unable to complete the foto lumbar intake prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
G9734 | Patient refused to participate |
G9735 | Patient unable to complete the foto shoulder intake prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
G9736 | Patient refused to participate |
G9737 | Patient unable to complete the foto elbow, wrist or hand intake prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
G9738 | Patient refused to participate |
G9739 | Patient unable to complete the foto general orthopedic intake prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available |
G9740 | Hospice services given to patient any time during the measurement period |
G9741 | Patients who use hospice services any time during the measurement period |
G9742 | Psychiatric symptoms assessed |
G9743 | Psychiatric symptoms not assessed, reason not otherwise specified |
G9744 | Patient not eligible due to active diagnosis of hypertension |
G9745 | Documented reason for not screening or recommending a follow-up for high blood pressure |
G9746 | Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery) |
G9747 | Patient is undergoing palliative dialysis with a catheter |
G9748 | Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant |
G9749 | Patient is undergoing palliative dialysis with a catheter |
G9750 | Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant |
G9751 | Patient died at any time during the 24-month measurement period |
G9752 | Emergency surgery |
G9753 | Documentation of medical reason for not conducting a search for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of the essence) |
G9754 | A finding of an incidental pulmonary nodule |
G9755 | Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has a known malignancy that can metastasize, other medical reason(s) |
G9756 | Surgical procedures that included the use of silicone oil |
G9757 | Surgical procedures that included the use of silicone oil |
G9758 | Patient in hospice and in terminal phase |
G9759 | History of preoperative posterior capsule rupture |
G9760 | Patients who use hospice services any time during the measurement period |
G9761 | Patients who use hospice services any time during the measurement period |
G9762 | Patient had at least three hpv vaccines on or between the patient's 9th and 13th birthdays |
G9763 | Patient did not have at least three hpv vaccines on or between the patient's 9th and 13th birthdays |
G9764 | Patient has been treated with an oral systemic or biologic medication for psoriasis |
G9765 | Documentation that the patient declined therapy change, has documented contraindications, or has not been treated with an oral systemic or biologic for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi |
G9766 | Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment |
G9767 | Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment |
G9768 | Patients who utilize hospice services any time during the measurement period |
G9769 | Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months |
G9770 | Peripheral nerve block (pnb) |
G9771 | At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time |
G9772 | Documentation of one of the following 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) achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.) |
G9773 | At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time |
G9774 | Patients who have had a hysterectomy |
G9775 | Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively |
G9776 | Documentation of medical reason for not receiving at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason) |
G9777 | Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively |
G9778 | Patients who have a diagnosis of pregnancy |
G9779 | Patients who are breastfeeding |
G9780 | Patients who have a diagnosis of rhabdomyolysis |
G9781 | Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, and patients with end stage renal disease (esrd)) |
G9782 | History of or active diagnosis of familial or pure hypercholesterolemia |
G9783 | Documentation of patients with diabetes who have a most recent fasting or direct ldl- c laboratory test result < 70 mg/dl and are not taking statin therapy |
G9784 | Pathologists/dermatopathologists providing a second opinion on a biopsy |
G9785 | Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell carcinoma (to include in situ disease) sent from the pathologist/dermatopathologist to the biopsying clinician for review within 7 business days from the time when the tissue specimen was received by the pathologist |
G9786 | Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell carcinoma (to include in situ disease) was not sent from the pathologist/dermatopathologist to the biopsying clinician for review within 7 business days from the time when the tissue specimen was received by the pathologist |
G9787 | Patient alive as of the last day of the measurement year |
G9788 | Most recent bp is less than or equal to 140/90 mm hg |
G9789 | Blood pressure recorded during inpatient stays, emergency room visits, urgent care visits, and patient self-reported bp's (home and health fair bp results) |
G9790 | Most recent bp is greater than 140/90 mm hg, or blood pressure not documented |
G9791 | Most recent tobacco status is tobacco free |
G9792 | Most recent tobacco status is not tobacco free |
G9793 | Patient is currently on a daily aspirin or other antiplatelet |
G9794 | Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g. history of gastrointestinal bleed or intra-cranial bleed or documentation of active anticoagulant use during the measurement period |
G9795 | Patient is not currently on a daily aspirin or other antiplatelet |
G9796 | Patient is currently on a statin therapy |
G9797 | Patient is not on a statin therapy |
G9798 | Discharge(s) for ami between july 1 of the year prior measurement year to june 30 of the measurement period |
G9799 | Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure period |
G9800 | Patients who are identified as having an intolerance or allergy to beta-blocker therapy |
G9801 | Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis` |
G9802 | Patients who use hospice services any time during the measurement period |
G9803 | Patient prescribed a 180-day course of treatment with beta-blockers post discharge for ami |
G9804 | Patient was not prescribed a 180-day course of treatment with beta-blockers post discharge for ami |
G9805 | Patients who use hospice services any time during the measurement period |
G9806 | Patients who received cervical cytology or an hpv test |
G9807 | Patients who did not receive cervical cytology or an hpv test |
G9808 | Any patients who had no asthma controller medications dispensed during the measurement year |
G9809 | Patients who use hospice services any time during the measurement period |
G9810 | Patient achieved a pdc of at least 75% for their asthma controller medication |
G9811 | Patient did not achieve a pdc of at least 75% for their asthma controller medication |
G9812 | Patient died including all deaths occurring during the hospitalization in which the operation was performed, even if after 30 days, and those deaths occurring after discharge from the hospital, but within 30 days of the procedure |
G9813 | Patient did not die within 30 days of the procedure or during the index hospitalization |
G9814 | Death occurring during hospitalization |
G9815 | Death did not occur during hospitalization |
G9816 | Death occurring 30 days post procedure |
G9817 | Death did not occur 30 days post procedure |
G9818 | Documentation of sexual activity |
G9819 | Patients who use hospice services any time during the measurement period |
G9820 | Documentation of a chlamydia screening test with proper follow-up |
G9821 | No documentation of a chlamydia screening test with proper follow-up |
G9822 | Women who had an endometrial ablation procedure during the year prior to the index date (exclusive of the index date) |
G9823 | Endometrial sampling or hysteroscopy with biopsy and results documented |
G9824 | Endometrial sampling or hysteroscopy with biopsy and results not documented |
G9825 | Her-2/neu negative or undocumented/unknown |
G9826 | Patient transferred to practice after initiation of chemotherapy |
G9827 | Her2-targeted therapies not administered during the initial course of treatment |
G9828 | Her2-targeted therapies administered during the initial course of treatment |
G9829 | Breast adjuvant chemotherapy administered |
G9830 | Her-2/neu positive |
G9831 | Ajcc stage at breast cancer diagnosis = ii or iii |
G9832 | Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis does not equal = t1, t1a, t1b |
G9833 | Patient transfer to practice after initiation of chemotherapy |
G9834 | Patient has metastatic disease at diagnosis |
G9835 | Trastuzumab administered within 12 months of diagnosis |
G9836 | Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete) |
G9837 | Trastuzumab not administered within 12 months of diagnosis |
G9838 | Patient has metastatic disease at diagnosis |
G9839 | Anti-egfr monoclonal antibody therapy |
G9840 | Kras gene mutation testing performed before initiation of anti-egfr moab |
G9841 | Kras gene mutation testing not performed before initiation of anti-egfr moab |
G9842 | Patient has metastatic disease at diagnosis |
G9843 | Kras gene mutation |
G9844 | Patient did not receive anti-egfr monoclonal antibody therapy |
G9845 | Patient received anti-egfr monoclonal antibody therapy |
G9846 | Patients who died from cancer |
G9847 | Patient received chemotherapy in the last 14 days of life |
G9848 | Patient did not receive chemotherapy in the last 14 days of life |
G9849 | Patients who died from cancer |
G9850 | Patient had more than one emergency department visit in the last 30 days of life |
G9851 | Patient had one or less emergency department visits in the last 30 days of life |
G9852 | Patients who died from cancer |
G9853 | Patient admitted to the icu in the last 30 days of life |
G9854 | Patient was not admitted to the icu in the last 30 days of life |
G9855 | Patients who died from cancer |
G9856 | Patient was not admitted to hospice |
G9857 | Patient admitted to hospice |
G9858 | Patient enrolled in hospice |
G9859 | Patients who died from cancer |
G9860 | Patient spent less than three days in hospice care |
G9861 | Patient spent greater than or equal to three days in hospice care |
G9862 | Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons) |