HCPCS 2017

G9744 Patient not eligible due to active diagnosis of hypertension
G9820 Documentation of a chlamydia screening test with proper follow-up
G9819 Patients who use hospice services any time during the measurement period
G9818 Documentation of sexual activity
G9817 Death did not occur 30 days post procedure
G9816 Death occurring 30 days post procedure
G9815 Death did not occur during hospitalization
G9814 Death occurring during hospitalization
G9813 Patient did not die within 30 days of the procedure or during the index hospitalization
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
G9811 Patient did not achieve a pdc of at least 75% for their asthma controller medication
G9810 Patient achieved a pdc of at least 75% for their asthma controller medication
G9809 Patients who use hospice services any time during the measurement period
G9808 Any patients who had no asthma controller medications dispensed during the measurement year
G9807 Patients who did not receive cervical cytology or an hpv test
G9806 Patients who received cervical cytology or an hpv test
G9805 Patients who use hospice services any time during the measurement period
G9804 Patient was not prescribed a 180-day course of treatment with beta-blockers post discharge for ami
G9803 Patient prescribed a 180-day course of treatment with beta-blockers post discharge for ami
G9802 Patients who use hospice services any time during the measurement period
G9801 Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis`
G9800 Patients who are identified as having an intolerance or allergy to beta-blocker therapy
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
G9798 Discharge(s) for ami between july 1 of the year prior measurement year to june 30 of the measurement period
G9797 Patient is not on a statin therapy
G9796 Patient is currently on a statin therapy
G9795 Patient is not 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
G9793 Patient is currently on a daily aspirin or other antiplatelet
G9792 Most recent tobacco status is not tobacco free
G9791 Most recent tobacco status is tobacco free
G9790 Most recent bp is greater than 140/90 mm hg, or blood pressure not documented
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)
G9787 Patient alive as of the last day of the measurement year
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
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
G9784 Pathologists/dermatopathologists providing a second opinion on a biopsy
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
G9782 History of or active diagnosis of familial or pure hypercholesterolemia
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))
G9780 Patients who have a diagnosis of rhabdomyolysis
G9779 Patients who are breastfeeding
G9778 Patients who have a diagnosis of pregnancy
G9777 Patient did not receive 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)
G9775 Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
G9774 Patients who have had a hysterectomy
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
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.)
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
G9770 Peripheral nerve block (pnb)
G9769 Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months
G9768 Patients who utilize hospice services any time during the measurement period
G9767 Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment
G9766 Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment
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
G9764 Patient has been treated with an oral systemic or biologic medication for psoriasis
G9763 Patient did not have at least three hpv vaccines on or between the patient's 9th and 13th birthdays
G9762 Patient had at least three hpv vaccines on or between the patient's 9th and 13th birthdays
G9761 Patients who use hospice services any time during the measurement period
G9760 Patients who use hospice services any time during the measurement period
G9759 History of preoperative posterior capsule rupture
G9758 Patient in hospice and in terminal phase
G9757 Surgical procedures that included the use of silicone oil
G9756 Surgical procedures that included the use of silicone oil
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)
G9754 A finding of an incidental pulmonary nodule
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)
G9752 Emergency surgery
G9751 Patient died at any time during the 24-month measurement period
G9750 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
G9748 Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
G9747 Patient is undergoing palliative dialysis with a catheter
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)
G9745 Documented reason for not screening or recommending a follow-up for high blood pressure
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
G9732 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
G9730 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
G9728 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
G9726 Patient refused to participate
G9725 Patients who use hospice services any time during the measurement period
G9724 Patients who had documentation of use of anticoagulant medications overlapping the measurement year
G9723 Hospice services for patient received any time during the measurement period
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
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
G9720 Hospice services for patient occurred 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
G9718 Hospice services for patient provided any time during the measurement period
G9717 Documentation stating the patient has an active diagnosis of depression or has a diagnosed bipolar disorder, therefore screening or follow-up not required
G9716 Bmi is documented as being outside of normal limits, follow-up plan is not completed for documented reason
G9715 Patients who use hospice services any time during the measurement period
G9714 Patient is using hospice services any time during the measurement period
G9713 Patients who use hospice services any time during the measurement period
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
G9711 Patients with a diagnosis or past history of total colectomy or colorectal cancer
G9710 Patient was provided hospice services any time during the measurement period
G9709 Hospice services used by patient 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
G9707 Patient received hospice services any time during the measurement period
G9706 Low (or very low) risk of recurrence, prostate cancer
G9705 Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented
G9704 Ajcc breast cancer stage i: t1 mic or t1a documented
G9703 Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis
G9702 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
G9700 Patients who use hospice services any time during the measurement period
G9699 Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified
G9698 Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator
G9697 Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator
G9695 Long-acting inhaled bronchodilator prescribed
G9694 Hospice services utilized by patient any time during the measurement period
G9693 Patient use of hospice services any time during the measurement period
G9692 Hospice services received by patient any time during the measurement period
G9691 Patient had hospice services any time during the measurement period
G9690 Patient receiving hospice services any time during the measurement period
G9689 Patient admitted for performance of elective carotid intervention
G9688 Patients using hospice services any time during the measurement period
G9687 Hospice services provided to patient any time during the measurement period
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
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
G9788 Most recent bp is less than or equal to 140/90 mm hg
G9696 Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator
G9821 No documentation of a chlamydia screening test with proper follow-up
G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth
G0508 Telehealth consultation, critical care, initial , physicians typically spend 60 minutes communicating with the patient and providers via telehealth
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
G0506 Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service)
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
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)
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
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
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)
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)
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)
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
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
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)
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)
G0492 Dialysis procedure with single evaluation by a physician or other qualified health care professional for acute kidney injury without esrd
G0491 Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd
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)
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)
G9861 Patient spent greater than or equal to three days in hospice care
G9860 Patient spent less than three days in hospice care
G9859 Patients who died from cancer
G9858 Patient enrolled in hospice
G9857 Patient admitted to hospice
G9856 Patient was not admitted to hospice
G9855 Patients who died from cancer
G9854 Patient was not admitted to the icu in the last 30 days of life
G9853 Patient admitted to the icu in the last 30 days of life
G9852 Patients who died from cancer
G9851 Patient had one or less emergency department visits in the last 30 days of life
G9850 Patient had more than one emergency department visit in the last 30 days of life
G9849 Patients who died from cancer
G9848 Patient did not receive chemotherapy in the last 14 days of life
G9847 Patient received chemotherapy in the last 14 days of life
G9846 Patients who died from cancer
G9845 Patient received anti-egfr monoclonal antibody therapy
G9844 Patient did not receive anti-egfr monoclonal antibody therapy
G9843 Kras gene mutation
G9842 Patient has metastatic disease at diagnosis
G9841 Kras gene mutation testing not performed before initiation of anti-egfr moab
G9840 Kras gene mutation testing performed before initiation of anti-egfr moab
G9839 Anti-egfr monoclonal antibody therapy
G9838 Patient has metastatic disease at diagnosis
G9837 Trastuzumab not 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)
G9835 Trastuzumab administered within 12 months of diagnosis
G9834 Patient has metastatic disease at diagnosis
G9833 Patient transfer to practice after initiation of chemotherapy
G9832 Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis does not equal = t1, t1a, t1b
G9831 Ajcc stage at breast cancer diagnosis = ii or iii
G9830 Her-2/neu positive
G9829 Breast adjuvant chemotherapy administered
G9828 Her2-targeted therapies administered during the initial course of treatment
G9827 Her2-targeted therapies not administered during the initial course of treatment
G9826 Patient transferred to practice after initiation of chemotherapy
G9824 Endometrial sampling or hysteroscopy with biopsy and results not documented
G9823 Endometrial sampling or hysteroscopy with biopsy and results documented
G9822 Women who had an endometrial ablation procedure during the year prior to the index date (exclusive of the index date)
G9825 Her-2/neu negative or undocumented/unknown
G9743 Psychiatric symptoms not assessed, reason not otherwise specified
G9742 Psychiatric symptoms assessed
G9741 Patients who use hospice services any time during the measurement period
G9740 Hospice services given to patient any time during the measurement period
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
G9738 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
G9736 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
G9734 Patient refused to participate
G0428 Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)
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
G9685 This code is for the evaluation and management of a beneficiary's acute change in condition in a nursing facility
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
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
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
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
G0429 Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)
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
G0435 Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening
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
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
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
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
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
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
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
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
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
G8944 Ajcc melanoma cancer stage 0 through iic melanoma
G8946 Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells)
G8947 One or more neuropsychiatric symptoms
G8950 Pre-hypertensive or hypertensive blood pressure reading documented, and the indicated follow-up is documented
G8952 Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
G8955 Most recent assessment of adequacy of volume management documented
G8956 Patient 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
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
G0168-G0177 Wound Closure
G0173-G0177 Stereotactic Radiosurgery
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
G0175-G0177 Team Conference
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
G0179-G0182 Physician Services
G0333-G0340 Pharmacy Fees
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
G0281-G0283 Electrical Stimulation
G0337-E8002 Hospice
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
G0288-G0289 Angiography and Arthroscopy
Transcatheter Placement
G8999 Motor speech functional limitation, current status at therapy episode outset and at reporting intervals
G0120-G0122 Screening Service, Colorectal, Other
G9143 Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
G8006-G9139 Physician Quality Reporting Indicator Code
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
G9140-L4631 CMS Demonstration Project
G9148 National committee for quality assurance - level 1 medical home
H1N1 Administration and Vaccine
G9149 National committee for quality assurance - level 2 medical home
G9150 National committee for quality assurance - level 3 medical home
G0248-G0250 Demonstration, INR
G0257-G0260 Emergency Dialysis
G9151 Mapcp demonstration - state provided services
G9152 Mapcp demonstration - community health teams
G0259-G0260 Arthrography Injection
G9153 Mapcp demonstration - physician incentive pool
G0268-G0271 Cerumen Removal
G0269-G0271 Placement of Occlusive Device
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
G0270-G0271 Nutrition Therapy
G9158 Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
G0275-G0278 Angiography
G0364-G0372 Bone Marrow Aspiration
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
G0365-G0372 Vessel Mapping
G9161 Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
G0378-G0384 Hospital Services
G9162 Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals
G0389-G0397 Ultrasound Scan for AAA
G9163 Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G0202-G0206 Mammography
G9164 Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting
G0390-G0397 Trauma Response Services
G9165 Attention functional limitation, current status at therapy episode outset and at reporting intervals
G0219-G0235 PET Imaging
G0398-G0400 Substance Abuse Assessment and Intervention
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
G0402-G0405 Home Sleep Study Test
G0252-G0260 Additional PET Imaging
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
G0403-G0405 Preventive Examination
G0406-G0408 Electrocardiogram
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
G0409-G0411 Telehealth Followup
G0412-G0415 Psychological Services
G9172 Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G0416-G0419 Bone Treatment
G9173 Voice functional limitation, discharge status at discharge from therapy or to end reporting
G0245-G0246 Physician Services, Diabetic
G9174 Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals
G0341-G0343 Islet Cell Transplant
G9175 Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G0251-V2025 Stereotactic Radiosurgery
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
G0293-G0294 Non-covered Procedures
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
G0302-G0305 Pulmonary Surgery Services
G9188 Beta-blocker therapy not prescribed, reason not given
G0306-G0328 Laboratory Services
G9189 Beta-blocker therapy prescribed or currently being taken
G0027-G0103 Semen Analysis
G0420-G0421 Surgical Pathology
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)
G0329-G0340 Electromagnetic Therapy
G0422-G0424 Educational Services
G9192 Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)
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))
G0339-G0340 Robotic Radiosurgery
Telehealth Consultation
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
G0008-G0010 Vaccine Adminstration
G0255-G0260 Sensory Nerve Conduction Testing
G0176-G0177 Activity Therapy
G0237-G0239 Therapeutic Procedures
G0101-G0103 Cervical Screening
G0102-G0103 Screening Services, Prostate
G0104-G0106 Screening Services, Colorectal
G0108-G0109 Training Services, Diabetes
G0117-G0118 Screening Services, Glaucoma
G0425-G0427 Rehabilitation Services
G0247-G0250 Diabetic Foot Care
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
G0186-G0206 Destruction
G0295-G0305 Electromagnetic Therapy
G0123-G0124 Screening Services, Cytopathology
G0127-G0129 Nail Trimming
G0128-G0129 Services, Nursing and Occupational Therapy
G9223 Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
G9225 Foot exam was not performed, reason not given
G0130-G0148 SEXA Study
G0141-G0148 Screening Services, Cytopathology, Other
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
G0151-G0166 Allied Health Services
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)
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
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
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
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
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
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
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
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
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
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)]
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
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
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
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
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
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
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
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
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
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))
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
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
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
G9668 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)
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
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