G-Codes
G9000–G9999: Procedures and Professional Services (Temporary)
G9000–G9999
- G9001Coordinated care fee, initial rate
- G9002Coordinated care fee, maintenance rate
- G9003Coordinated care fee, risk adjusted high, initial
- G9004Coordinated care fee, risk adjusted low, initial
- G9005Coordinated care fee, risk adjusted maintenance
- G9006Coordinated care fee, home monitoring
- G9007Coordinated care fee, scheduled team conference
- G9008Coordinated care fee, physician coordinated care oversight services
- G9009Coordinated care fee, risk adjusted maintenance, level 3
- G9010Coordinated care fee, risk adjusted maintenance, level 4
- G9011Coordinated care fee, risk adjusted maintenance, level 5
- G9012Other specified case management service not elsewhere classified
- G9013Esrd demo basic bundle level i
- G9014Esrd demo expanded bundle including venous access and related services
- G9016Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only]
- G9017Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
- G9018Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project)
- G9019Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project)
- G9020Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
- G9033Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project)
- G9034Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project)
- G9035Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project)
- G9036Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project)
- G9037Interprofessional telephone/internet/electronic health record clinical question/request for specialty recommendations by a treating/requesting physician or other qualified health care professional for the care of the patient (i.e. not for professional education or scheduling) and may include subsequent follow up on the specialist's recommendations; 30 minutes
- G9038Co-management services with the following elements: new diagnosis or acute exacerbation and stabilization of existing condition; condition which may benefit from joint care planning; condition for which specialist is taking a co-management role; condition expected to last at least 3 months; comprehensive care plan established, implemented, revised or monitored in partnership with co-managing clinicians; ongoing communication and care coordination between co-managing clinicians furnishing care
- G9050Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project)
- G9051Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project)
- G9052Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
- G9053Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
- G9054Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project)
- G9055Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project)
- G9056Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project)
- G9057Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project)
- G9058Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project)
- G9059Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project)
- G9060Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project)
- G9061Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project)
- G9062Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project)
- G9063Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9064Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9065Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9066Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
- G9067Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9068Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9069Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
- G9070Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9071Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9072Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9073Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9074Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9075Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
- G9077Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9078Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9079Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9080Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project)
- G9083Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9084Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9085Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9086Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9087Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
- G9088Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
- G9089Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9090Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9091Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9092Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project)
- G9093Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9094Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
- G9095Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9096Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9097Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9098Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
- G9099Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9100Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project)
- G9101Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
- G9102Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
- G9103Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
- G9104Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9105Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9106Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
- G9107Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
- G9108Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9109Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9110Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9111Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
- G9112Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9113Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9114Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9115Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
- G9116Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project)
- G9117Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9123Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
- G9124Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
- G9125Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
- G9126Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
- G9128Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project)
- G9129Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project)
- G9130Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9131Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
- G9132Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project)
- G9133Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project)
- G9134Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project)
- G9135Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project)
- G9136Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project)
- G9137Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project)
- G9138Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project)
- G9139Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project)
- G9140Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours
- G9143Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
- G9147Outpatient 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
- G9148National committee for quality assurance - level 1 medical home
- G9149National committee for quality assurance - level 2 medical home
- G9150National committee for quality assurance - level 3 medical home
- G9151Mapcp demonstration - state provided services
- G9152Mapcp demonstration - community health teams
- G9153Mapcp demonstration - physician incentive pool
- G9156Evaluation for wheelchair requiring face to face visit with physician
- G9157Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes
- G9158Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
- G9159Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals
- G9160Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
- G9161Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
- G9162Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals
- G9163Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
- G9164Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting
- G9165Attention functional limitation, current status at therapy episode outset and at reporting intervals
- G9166Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
- G9167Attention functional limitation, discharge status at discharge from therapy or to end reporting
- G9168Memory functional limitation, current status at therapy episode outset and at reporting intervals
- G9169Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
- G9170Memory functional limitation, discharge status at discharge from therapy or to end reporting
- G9171Voice functional limitation, current status at therapy episode outset and at reporting intervals
- G9172Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
- G9173Voice functional limitation, discharge status at discharge from therapy or to end reporting
- G9174Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals
- G9175Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
- G9176Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting
- G9186Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
- G9187Bundled 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
- G9188Beta-blocker therapy not prescribed, reason not given
- G9189Beta-blocker therapy prescribed or currently being taken
- G9190Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons)
- G9191Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons)
- G9192Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)
- G9193Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression
- G9194Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase
- G9195Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase
- G9196Documentation 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))
- G9197Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis
- G9198Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given
- G9199Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s))
- G9200Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given
- G9201Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission
- G9202Patients with a positive hepatitis c antibody test
- G9203Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
- G9204Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
- G9205Patient starting antiviral treatmentfor hepatitis c during the measurement period
- G9206Patient starting antiviral treatment for hepatitis c during the measurement period
- G9207Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
- G9208Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
- G9209Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment
- G9210Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons)
- G9211Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given
- G9212Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
- G9213Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
- G9214Cd4+ cell count or cd4+ cell percentage results documented
- G9215Cd4+ cell count or percentage not documented as performed, reason not given
- G9216Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
- G9217Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given
- G9218Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given
- G9219Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
- G9220Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
- G9221Pneumocystis jiroveci pneumonia prophlaxis prescribed
- G9222Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3
- G9223Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
- G9224Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)
- G9225Foot exam was not performed, reason not given
- G9226Foot 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)
- G9227Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter
- G9228Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings)
- G9229Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception)
- G9230Chlamydia, gonorrhea, and syphilis not screened, reason not given
- G9231Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period
- G9232Clinician 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)
- G9233All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient
- G9234I intend to report the total knee replacement measures group
- G9235All quality actions for the applicable measures in the general surgery measures group have been performed for this patient
- G9236All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient
- G9237I intend to report the general surgery measures group
- G9238I intend to report the optimizing patient exposure to ionizing radiation measures group
- G9239Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing arteriovenous fistula (avf)/arteriovenous graft (avg), time-limited trial of hemodialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons)
- G9240Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
- G9241Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated
- G9242Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
- G9243Documentation of viral load less than 200 copies/ml
- G9244Antiretroviral thereapy not prescribed
- G9245Antiretroviral therapy prescribed
- G9246Patient did not have two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart
- G9247Patient had two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart
- G9248Patient did not have a medical visit in the last 6 months
- G9249Patient had a medical visit in the last 6 months
- G9250Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment
- G9251Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment
- G9252Adenoma(s) or other neoplasm detected during screening colonoscopy
- G9253Adenoma(s) or other neoplasm not detected during screening colonoscopy
- G9254Documentation of patient discharged to home later than post-operative day 2 following cea or cas
- G9255Documentation of patient discharged to home no later than post operative day 2 following cea or cas
- G9256Documentation of patient death following cas
- G9257Documentation of patient stroke following cas
- G9258Documentation of patient stroke following cea
- G9259Documentation of patient survival and absence of stroke following cas
- G9260Documentation of patient death following cea
- G9261Documentation of patient survival and absence of stroke following cea
- G9262Documentation of patient death in the hospital following endovascular aaa repair
- G9263Documentation of patient discharged alive following endovascular aaa repair
- G9264Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons)
- G9265Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access
- G9266Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access
- G9267Documentation of patient with one or more complications or mortality within 30 days
- G9268Documentation of patient with one or more complications within 90 days
- G9269Documentation of patient without one or more complications and without mortality within 30 days
- G9270Documentation of patient without one or more complications within 90 days
- G9271Ldl value < 100
- G9272Ldl value >= 100
- G9273Blood pressure has a systolic value of < 140 and a diastolic value of < 90
- G9274Blood 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
- G9275Documentation that patient is a current non-tobacco user
- G9276Documentation that patient is a current tobacco user
- G9277Documentation 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)
- G9278Documentation that the patient is not on daily aspirin or anti-platelet regimen
- G9279Pneumococcal screening performed and documentation of vaccination received prior to discharge
- G9280Pneumococcal vaccination not administered prior to discharge, reason not specified
- G9281Screening performed and documentation that vaccination not indicated/patient refusal
- G9282Documentation 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)
- G9283Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
- G9284Non 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
- G9285Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer
- G9286Antibiotic regimen prescribed within 10 days after onset of symptoms
- G9287Antibiotic regimen not prescribed within 10 days after onset of symptoms
- G9288Documentation 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)
- G9289Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
- G9290Non 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
- G9291Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos
- G9292Documentation 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)
- G9293Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
- G9294Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
- G9295Specimen site other than anatomic cutaneous location
- G9296Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure
- G9297Shared 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
- G9298Patients 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)
- G9299Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given)
- G9300Documentation 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)
- G9301Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet
- G9302Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given
- G9303Operative 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
- G9304Operative 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
- G9305Intervention for presence of leak of endoluminal contents through an anastomosis not required
- G9306Intervention for presence of leak of endoluminal contents through an anastomosis required
- G9307No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
- G9308Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
- G9309No unplanned hospital readmission within 30 days of principal procedure
- G9310Unplanned hospital readmission within 30 days of principal procedure
- G9311No surgical site infection
- G9312Surgical site infection
- G9313Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason
- G9314Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given
- G9315Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis
- G9316Documentation 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
- G9317Documentation 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
- G9318Imaging study named according to standardized nomenclature
- G9319Imaging study not named according to standardized nomenclature, reason not given
- G9320Documentation of medical reason(s) for not naming ct studies according to a standardized nomenclature provided (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
- G9321Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies documented in the 12-month period prior to the current study
- G9322Count of previous ct and cardiac nuclear medicine (myocardial perfusion or infarct avid imaging) studies not documented in the 12-month period prior to the current study, reason not given
- G9323Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
- G9324All necessary data elements not included, reason not given
- G9325Ct studies not reported to a radiation dose index registry due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
- G9326Ct 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
- G9327Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements
- G9328Dicom format image data availability not documented in final report due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
- G9329Dicom 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
- G9340Final 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
- G9341Search 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
- G9342Search 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
- G9343Due to medical reasons, search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
- G9344Due 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)
- G9345Follow-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
- G9346Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
- G9347Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given
- G9348Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons
- G9349Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis
- G9350Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis
- G9351More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis
- G9352More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given
- G9353More 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)
- G9354One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis
- G9355Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation)
- G9356Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation)
- G9357Post-partum screenings, evaluations and education performed
- G9358Post-partum screenings, evaluations and education not performed
- G9359Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier
- G9360No documentation of negative or managed positive tb screen
- G9361Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]
- G9362Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record
- G9363Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record
- G9364Sinusitis caused by, or presumed to be caused by, bacterial infection
- G9365One high-risk medication ordered
- G9366One high-risk medication not ordered
- G9367At least two orders for high-risk medications from the same drug class
- G9368At least two orders for high-risk medications from the same drug class not ordered
- G9369Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater
- G9370Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater
- G9376Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery
- G9377Patient did not have the retina attached after 6 months following only one surgery
- G9378Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month)
- G9379Patient did not achieve flat retinas six months post surgery
- G9380Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period
- G9381Documentation 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
- G9382Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period
- G9383Patient received screening for hcv infection within the 12 month reporting period
- G9384Documentation 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)
- G9385Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons)
- G9386Screening for hcv infection not received within the 12 month reporting period, reason not given
- G9389Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
- G9390No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
- G9391Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
- G9392Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
- G9393Patient 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
- G9394Patient 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
- G9395Patient 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
- G9396Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days)
- G9399Documentation 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
- G9400Documentation 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
- G9401No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
- G9402Patient received follow-up within 30 days after discharge
- G9403Clinician 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)
- G9404Patient did not receive follow-up within 30 days after discharge
- G9405Patient received follow-up within 7 days after discharge
- G9406Clinician 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)
- G9407Patient did not receive follow-up within 7 days after discharge
- G9408Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days
- G9409Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days
- G9410Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
- G9411Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
- G9412Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
- G9413Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
- G9414Patient had one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b) on or between the patient's 10th and 13th birthdays
- G9415Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y or a, c, w, y, b), on or between the patient's 10th and 13th birthdays
- G9416Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays
- G9417Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays
- G9418Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation
- G9419Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons)
- G9420Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer
- G9421Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation
- G9422Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos)
- G9423Documentation 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)]
- G9424Specimen site other than anatomic location of lung, or classified as nsclc-nos
- G9425Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma)
- G9426Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients
- G9427Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients
- G9428Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
- G9429Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons)
- G9430Specimen site other than anatomic cutaneous location
- G9431Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
- G9432Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented
- G9433Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period
- G9434Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given
- G9435Aspirin prescribed at discharge
- G9436Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
- G9437Aspirin not prescribed at discharge
- G9438P2y inhibitor prescribed at discharge
- G9439P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
- G9440P2y inhibitor not prescribed at discharge
- G9441Statin prescribed at discharge
- G9442Statin not prescribed for documented reasons (e.g., allergy, medical intolerance)
- G9443Statin not prescribed at discharge
- G9448Patients who were born in the years 1945 to 1965
- G9449History of receiving blood transfusions prior to 1992
- G9450History of injection drug use
- G9451Patient received one-time screening for hcv infection
- G9452Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy
- G9453Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons)
- G9454One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given
- G9455Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc
- G9456Documentation 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)
- G9457Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period
- G9458Patient 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
- G9459Currently a tobacco non-user
- G9460Tobacco assessment or tobacco cessation intervention not performed, reason not given
- G9463I intend to report the sinusitis measures group
- G9464All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient
- G9465I intend to report the acute otitis externa (aoe) measures group
- G9466All quality actions for the applicable measures in the aoe measures group have been performed for this patient
- G9467Patient who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills within the last twelve months
- G9468Patient 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
- G9469Patients who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 90 or greater consecutive days or a single prescription equating to 900 mg prednisone or greater for all fills
- G9470Patients 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
- G9471Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented
- G9472Within 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
- G9473Services performed by chaplain in the hospice setting, each 15 minutes
- G9474Services performed by dietary counselor in the hospice setting, each 15 minutes
- G9475Services performed by other counselor in the hospice setting, each 15 minutes
- G9476Services performed by volunteer in the hospice setting, each 15 minutes
- G9477Services performed by care coordinator in the hospice setting, each 15 minutes
- G9478Services performed by other qualified therapist in the hospice setting, each 15 minutes
- G9479Services performed by qualified pharmacist in the hospice setting, each 15 minutes
- G9480Admission to medicare care choice model program (mccm)
- G9481Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9482Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9483Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9484Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9485Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9486Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9487Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9488Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9489Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9490Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code
- G9496Documentation 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
- G9497Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery
- G9498Antibiotic regimen prescribed
- G9499Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period
- G9500Radiation exposure indices documented in final report for procedure using fluoroscopy
- G9501Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given
- G9502Documentation 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)
- G9503Patient taking tamsulosin hydrochloride
- G9504Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
- G9505Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
- G9506Biologic immune response modifier prescribed
- G9507Documentation 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)
- G9508Documentation that the patient is not on a statin medication
- G9509Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
- G9510Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5
- G9511Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
- G9512Individual had a pdc of 0.8 or greater
- G9513Individual did not have a pdc of 0.8 or greater
- G9514Patient required a return to the operating room within 90 days of surgery
- G9515Patient did not require a return to the operating room within 90 days of surgery
- G9516Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery
- G9517Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given
- G9518Documentation of active injection drug use
- G9519Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
- G9520Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
- G9521Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
- G9522Total 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
- G9523Patient discontinued from hemodialysis or peritoneal dialysis
- G9524Patient was referred to hospice care
- G9525Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)
- G9526Patient was not referred to hospice care, reason not given
- G9529Patient with minor blunt head trauma had an appropriate indication(s) for a head ct
- G9530Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
- G9531Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar
- G9532Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
- G9533Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct
- G9534Advanced brain imaging (cta, ct, mra or mri) was not ordered
- G9535Patients with a normal neurological examination
- G9536Documentation 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)
- G9537Imaging needed as part of a clinical trial; or other clinician ordered the study
- G9538Advanced brain imaging (cta, ct, mra or mri) was ordered
- G9539Intent for potential removal at time of placement
- G9540Patient alive 3 months post procedure
- G9541Filter removed within 3 months of placement
- G9542Documented re-assessment for the appropriateness of filter removal within 3 months of placement
- G9543Documentation 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
- G9544Patients 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
- G9547Cystic renal lesion that is simple appearing (bosniak i or ii) , or adrenal lesion less than or equal to 1.0 cm or adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced ct or washout protocol ct, or mri with in- and opposed-phase sequences or other equivalent institutional imaging protocols
- G9548Final reports for imaging studies stating no follow-up imaging is recommended
- G9549Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has lymphadenopathy, signs of metastasis or an active diagnosis or history of cancer, and other medical reason(s))
- G9550Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up
- G9551Final reports for imaging studies without an incidentally found lesion noted
- G9552Incidental thyroid nodule < 1.0 cm noted in report
- G9553Prior thyroid disease diagnosis
- G9554Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended
- G9555Documentation of medical reason(s) for recommending follow up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s))
- G9556Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended
- G9557Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found
- G9558Patient treated with a beta-lactam antibiotic as definitive therapy
- G9559Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics)
- G9560Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given
- G9561Patients prescribed opiates for longer than six weeks
- G9562Patients who had a follow-up evaluation conducted at least every three months during opioid therapy
- G9563Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy
- G9572Index date phq-score greater than 9 documented during the twelve month denominator identification period
- G9573Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five
- G9574Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was not assessed or is greater than or equal to five
- G9577Patients prescribed opiates for longer than six weeks
- G9578Documentation of signed opioid treatment agreement at least once during opioid therapy
- G9579No documentation of signed an opioid treatment agreement at least once during opioid therapy
- G9580Door to puncture time of 90 minutes or less
- G9581Door to puncture time of greater than 2 hours for reasons documented by clinician (e.g., patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment; hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment)
- G9582Door to puncture time of greater than 90 minutes, no reason given
- G9583Patients prescribed opiates for longer than six weeks
- G9584Patient 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
- G9585Patient 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
- G9593Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules
- G9594Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
- G9595Patient has documentation of ventricular shunt, brain tumor, or coagulopathy
- G9596Pediatric patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than trauma
- G9597Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules
- G9598Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
- G9599Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
- G9600Symptomatic aaas that required urgent/emergent (non-elective) repair
- G9601Patient discharge to home no later than post-operative day #7
- G9602Patient not discharged to home by post-operative day #7
- G9603Patient survey score improved from baseline following treatment
- G9604Patient survey results not available
- G9605Patient survey score did not improve from baseline following treatment
- G9606Intraoperative cystoscopy performed to evaluate for lower tract injury
- G9607Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death
- G9608Intraoperative cystoscopy not performed to evaluate for lower tract injury
- G9609Documentation of an order for anti-platelet agents
- G9610Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents
- G9611Order for anti-platelet agents was not documented in the patient's record, reason not given
- G9612Photodocumentation of two or more cecal landmarks to establish a complete examination
- G9613Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.)
- G9614Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination
- G9615Preoperative assessment documented
- G9616Documentation 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)
- G9617Preoperative assessment not documented, reason not given
- G9618Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
- G9619Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy)
- G9620Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given
- G9621Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling
- G9622Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
- G9623Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
- G9624Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user
- G9625Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- G9626Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury)
- G9627Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
- G9628Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- G9629Documented 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)
- G9630Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
- G9631Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
- G9632Documented 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)
- G9633Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
- G9634Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved
- G9635Health-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)
- G9636Health-related quality of life not assessed with tool during at least two visits or quality of life score declined
- G9637Final 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)
- G9638Final 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)
- G9639Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure
- G9640Documentation of planned hybrid or staged procedure
- G9641Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure
- G9642Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana)
- G9643Elective surgery
- G9644Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure
- G9645Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure
- G9646Patients with 90 day mrs score of 0 to 2
- G9647Patients in whom mrs score could not be obtained at 90 day follow-up
- G9648Patients with 90 day mrs score greater than 2
- G9649Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi))
- G9650Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
- G9651Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) or psoriasis assessment tool not documented
- G9652Patient has been treated with a systemic or biologic medication for psoriasis for at least six months
- G9653Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months
- G9654Monitored anesthesia care (mac)
- G9655A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used
- G9656Patient transferred directly from anesthetizing location to pacu or other non-icu location
- G9657Transfer of care during an anesthetic or to the intensive care unit
- G9658A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used
- G9659Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits
- G9660Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits)
- G9661Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions
- G9662Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure
- G9663Any ldl-c laboratory result >= 190 mg/dl
- G9664Patients who are currently statin therapy users or received an order (prescription) for statin therapy
- G9665Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy
- G9666Patient's highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl
- G9667Documentation 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)
- G9669I intend to report the multiple chronic conditions measures group
- G9670All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient
- G9671I intend to report the diabetic retinopathy measures group
- G9672All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient
- G9673I intend to report the cardiovascular prevention measures group
- G9674Patients with clinical ascvd diagnosis
- G9675Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl
- G9676Patients 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
- G9677All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient
- G9678Oncology 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
- G9679This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary
- G9680This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary
- G9681This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary
- G9682This 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
- G9683Facility service(s) for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder. (may only be billed once per day per beneficiary). this service is for a demonstration project
- G9684This 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
- G9685Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project
- G9686Onsite 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
- G9687Hospice services provided to patient any time during the measurement period
- G9688Patients using hospice services any time during the measurement period
- G9689Patient admitted for performance of elective carotid intervention
- G9690Patient receiving hospice services any time during the measurement period
- G9691Patient had hospice services any time during the measurement period
- G9692Hospice services received by patient any time during the measurement period
- G9693Patient use of hospice services any time during the measurement period
- G9694Hospice services utilized by patient any time during the measurement period
- G9695Long-acting inhaled bronchodilator prescribed
- G9696Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects)
- G9697Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator
- G9698Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance)
- G9699Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified
- G9700Patients who use hospice services any time during the measurement period
- G9701Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established
- G9702Patients who use hospice services any time during the measurement period
- G9703Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
- G9704Ajcc breast cancer stage i: t1 mic or t1a documented
- G9705Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented
- G9706Low (or very low) risk of recurrence, prostate cancer
- G9707Patient received hospice services any time during the measurement period
- G9708Women 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
- G9709Hospice services used by patient any time during the measurement period
- G9710Patient was provided hospice services any time during the measurement period
- G9711Patients with a diagnosis or past history of total colectomy or colorectal cancer
- G9712Documentation 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
- G9713Patients who use hospice services any time during the measurement period
- G9714Patient is using hospice services any time during the measurement period
- G9715Patients who use hospice services any time during the measurement period
- G9716Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
- G9717Documentation stating the patient has had a diagnosis of bipolar disorder
- G9718Hospice services for patient provided any time during the measurement period
- G9719Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
- G9720Hospice services for patient occurred any time during the measurement period
- G9721Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
- G9722Documented 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
- G9723Hospice services for patient received any time during the measurement period
- G9724Patients who had documentation of use of anticoagulant medications overlapping the measurement year
- G9725Patients who use hospice services any time during the measurement period
- G9726Patient refused to participate
- G9727Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
- G9728Patient refused to participate
- G9729Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
- G9730Patient refused to participate
- G9731Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
- G9732Patient refused to participate
- G9733Patient unable to complete the low back fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
- G9734Patient refused to participate
- G9735Patient unable to complete the shoulder fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
- G9736Patient refused to participate
- G9737Patient unable to complete the elbow/wrist/hand fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
- G9738Patient refused to participate
- G9739Patient unable to complete the general orthopedic fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
- G9740Hospice services given to patient any time during the measurement period
- G9741Patients who use hospice services any time during the measurement period
- G9742Psychiatric symptoms assessed
- G9743Psychiatric symptoms not assessed, reason not otherwise specified
- G9744Patient not eligible due to active diagnosis of hypertension
- G9745Documented reason for not screening or recommending a follow-up for high blood pressure
- G9746Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
- G9747Patient is undergoing palliative dialysis with a catheter
- G9748Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
- G9749Patient is undergoing palliative dialysis with a catheter
- G9750Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
- G9751Patient died at any time during the 24-month measurement period
- G9752Emergency surgery
- G9753Documentation 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)
- G9754A finding of an incidental pulmonary nodule
- G9755Documentation of medical reason(s) for not including a recommended interval and modality for follow-up or for no follow-up, and source of recommendations (e.g., patients with unexplained fever, immunocompromised patients who are at risk for infection)
- G9756Surgical procedures that included the use of silicone oil
- G9757Surgical procedures that included the use of silicone oil
- G9758Patient in hospice at any time during the measurement period
- G9759History of preoperative posterior capsule rupture
- G9760Patients who use hospice services any time during the measurement period
- G9761Patients who use hospice services any time during the measurement period
- G9762Patient had at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
- G9763Patient did not have at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
- G9764Patient has been treated with a systemic medication for psoriasis vulgaris
- G9765Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
- G9766Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment
- G9767Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment
- G9768Patients who utilize hospice services any time during the measurement period
- G9769Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months
- G9770Peripheral nerve block (pnb)
- G9771At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time
- G9772Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.)
- G9773At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time, reason not given
- G9774Patients who have had a hysterectomy
- G9775Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
- G9776Documentation 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)
- G9777Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
- G9778Patients who have a diagnosis of pregnancy at any time during the measurement period
- G9779Patients who are breastfeeding at any time during the performance period
- G9780Patients who have a diagnosis of rhabdomyolysis at any time during the performance period
- G9781Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease [esrd], or other medical reasons)
- G9782History of or active diagnosis of familial hypercholesterolemia
- G9783Documentation 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
- G9784Pathologists/dermatopathologists providing a second opinion on a biopsy
- G9785Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
- G9786Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) was not sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
- G9787Patient alive as of the last day of the measurement year
- G9788Most recent bp is less than or equal to 130/80 mm hg
- G9789Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits
- G9790Most recent bp is greater than 130/80 mm hg, or blood pressure not documented
- G9791Most recent tobacco status is tobacco free
- G9792Most recent tobacco status is not tobacco free
- G9793Patient is currently on a daily aspirin or other antiplatelet
- G9794Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)
- G9795Patient is not currently on a daily aspirin or other antiplatelet
- G9796Patient is currently on a high intensity statin therapy
- G9797Patient is not on a high intensity statin therapy
- G9798Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period
- G9799Patients 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
- G9800Patients who are identified as having an intolerance or allergy to beta-blocker therapy
- G9801Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis
- G9802Patients who use hospice services any time during the measurement period
- G9803Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
- G9804Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
- G9805Patients who use hospice services any time during the measurement period
- G9806Patients who received cervical cytology or an hpv test
- G9807Patients who did not receive cervical cytology or an hpv test
- G9808Any patients who had no asthma controller medications dispensed during the measurement year
- G9809Patients who use hospice services any time during the measurement period
- G9810Patient achieved a pdc of at least 75% for their asthma controller medication
- G9811Patient did not achieve a pdc of at least 75% for their asthma controller medication
- G9812Patient 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
- G9813Patient did not die within 30 days of the procedure or during the index hospitalization
- G9814Death occurring during the index acute care hospitalization
- G9815Death did not occur during the index acute care hospitalization
- G9816Death occurring after discharge from the hospital but within 30 days post procedure
- G9817Death did not occur after discharge from the hospital within 30 days post procedure
- G9818Documentation of sexual activity
- G9819Patients who use hospice services any time during the measurement period
- G9820Documentation of a chlamydia screening test with proper follow-up
- G9821No documentation of a chlamydia screening test with proper follow-up
- G9822Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date)
- G9823Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
- G9824Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
- G9825Her-2/neu negative or undocumented/unknown
- G9826Patient transferred to practice after initiation of chemotherapy
- G9827Her2-targeted therapies not administered during the initial course of treatment
- G9828Her2-targeted therapies administered during the initial course of treatment
- G9829Breast adjuvant chemotherapy administered
- G9830Her-2/neu positive
- G9831Ajcc stage at breast cancer diagnosis = ii or iii
- G9832Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis = t1c
- G9833Patient transfer to practice after initiation of chemotherapy
- G9834Patient has metastatic disease at diagnosis
- G9835Trastuzumab administered within 12 months of diagnosis
- G9836Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)
- G9837Trastuzumab not administered within 12 months of diagnosis
- G9838Patient has metastatic disease at diagnosis
- G9839Anti-egfr monoclonal antibody therapy
- G9840Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab
- G9841Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab
- G9842Patient has metastatic disease at diagnosis
- G9843Ras (kras or nras) gene mutation
- G9844Patient did not receive anti-egfr monoclonal antibody therapy
- G9845Patient received anti-egfr monoclonal antibody therapy
- G9846Patients who died from cancer
- G9847Patient received systemic cancer-directed therapy in the last 14 days of life
- G9848Patient did not receive systemic cancer-directed therapy in the last 14 days of life
- G9849Patients who died from cancer
- G9850Patient had more than one emergency department visit in the last 30 days of life
- G9851Patient had one or less emergency department visits in the last 30 days of life
- G9852Patients who died from cancer
- G9853Patient admitted to the icu in the last 30 days of life
- G9854Patient was not admitted to the icu in the last 30 days of life
- G9855Patients who died from cancer
- G9856Patient was not admitted to hospice
- G9857Patient admitted to hospice
- G9858Patient enrolled in hospice
- G9859Patients who died from cancer
- G9860Patient spent less than three days in hospice care
- G9861Patient spent greater than or equal to three days in hospice care
- G9862Documentation 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)
- G9868Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes
- G9869Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes
- G9870Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes
- G9871Behavioral counseling for diabetes prevention, online, 60 minutes
- G9873First medicare diabetes prevention program (mdpp) core session was attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
- G9874Four total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
- G9875Nine total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
- G9876Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9
- G9877Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12
- G9878Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions.the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9
- G9879Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12
- G9880The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight in months 1-12 of the mdpp services period under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 5% weight loss from baseline as measured by an in-person weight measurement at a core session or core maintenance session
- G9881The mdpp beneficiary achieved at least 9% weight loss (wl) from his/her baseline weight in months 1-24 under the mdpp expanded model (em). this is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session
- G9882Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 13-15 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 13-15
- G9883Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 16-18 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 16-18
- G9884Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 19-21 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 19-21
- G9885Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 22-24 under the mdpp expanded model (em). an ongoing maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary maintained at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24
- G9886Behavioral counseling for diabetes prevention, in-person, group, 60 minutes
- G9887Behavioral counseling for diabetes prevention, distance learning, 60 minutes
- G9888Maintenance 5% wl from baseline weight in months 7-12
- G9890Bridge payment: a one-time payment for the first medicare diabetes prevention program (mdpp) core session, core maintenance session, or ongoing maintenance session furnished by an mdpp supplier to an mdpp beneficiary during months 1-24 of the mdpp expanded model (em) who has previously received mdpp services from a different mdpp supplier under the mdpp expanded model. a supplier may only receive one bridge payment per mdpp beneficiary
- G9891Mdpp session reported as a line-item on a claim for a payable mdpp expanded model (em) hcpcs code for a session furnished by the billing supplier under the mdpp expanded model and counting toward achievement of the attendance performance goal for the payable mdpp expanded model hcpcs code (this code is for reporting purposes only)
- G9892Documentation of patient reason(s) for not performing a dilated macular examination
- G9893Dilated macular exam was not performed, reason not otherwise specified
- G9894Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate
- G9895Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy)
- G9896Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate
- G9897Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given
- G9898Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
- G9899Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
- G9900Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
- G9901Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
- G9902Patient screened for tobacco use and identified as a tobacco user
- G9903Patient screened for tobacco use and identified as a tobacco non-user
- G9904Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
- G9905Patient not screened for tobacco use
- G9906Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
- G9907Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months (e.g., limited life expectancy, other medical reason)
- G9908Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
- G9909Documentation of medical reason(s) for not providing tobacco cessation intervention on the date of the encounter or within the previous 12 months if identified as a tobacco user (e.g., limited life expectancy, other medical reason)
- G9910Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
- G9911Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy
- G9912Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy
- G9913Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified
- G9914Patient initiated an anti-tnf agent
- G9915No record of hbv results documented
- G9916Functional status performed once in the last 12 months
- G9917Documentation of advanced stage dementia and caregiver knowledge is limited
- G9918Functional status not performed, reason not otherwise specified
- G9919Screening performed and positive and provision of recommendations
- G9920Screening performed and negative
- G9921No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified
- G9922Safety concerns screen provided and if positive then documented mitigation recommendations
- G9923Safety concerns screen provided and negative
- G9924Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason)
- G9925Safety concerns screening not provided, reason not otherwise specified
- G9926Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources
- G9927Documentation of system reason(s) for not prescribing an fda-approved anticoagulation due to patient being currently enrolled in a clinical trial related to af/atrial flutter treatment
- G9928Fda-approved anticoagulant not prescribed, reason not given
- G9929Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
- G9930Patients who are receiving comfort care only
- G9931Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women
- G9932Documentation of patient reason(s) for not having records of negative or managed positive tb screen (e.g., patient does not return for mantoux (ppd) skin test evaluation)
- G9933Adenoma(s) or colorectal cancer detected during screening colonoscopy
- G9934Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
- G9935Adenoma(s) or colorectal cancer not detected during screening colonoscopy
- G9936Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus
- G9937Diagnostic colonoscopy
- G9938Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period
- G9939Pathologists/dermatopathologists is the same clinician who performed the biopsy
- G9940Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year)
- G9941Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively
- G9942Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
- G9943Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
- G9944Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
- G9945Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
- G9946Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
- G9947Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively
- G9948Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
- G9949Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
- G9954Patient exhibits 2 or more risk factors for post-operative vomiting
- G9955Cases in which an inhalational anesthetic is used only for induction
- G9956Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
- G9957Documentation of medical reason for not receiving combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)
- G9958Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
- G9959Systemic antimicrobials not prescribed
- G9960Documentation of medical reason(s) for prescribing systemic antimicrobials
- G9961Systemic antimicrobials prescribed
- G9962Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy
- G9963Embolization endpoints are not documented separately for each embolized vessel or ovarian artery angiography or embolization not performed in the presence of variant uterine artery anatomy
- G9964Patient received at least one well-child visit with a pcp during the performance period
- G9965Patient did not receive at least one well-child visit with a pcp during the performance period
- G9966Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
- G9967Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
- G9968Patient was referred to another clinician or specialist during the measurement period
- G9969Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred
- G9970Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred
- G9974Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity
- G9975Documentation of medical reason(s) for not performing a dilated macular examination
- G9978Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9979Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9980Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9981Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9982Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9983Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9984Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9985Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9986Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved bundled payments for care improvement advanced (bpci advanced) model episode of care, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
- G9987Bundled payments for care improvement advanced (bpci advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a bpci advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code
- G9988Palliative care services provided to patient any time during the measurement period
- G9989Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
- G9990Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
- G9991Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
- G9992Palliative care services used by patient any time during the measurement period
- G9993Patient was provided palliative care services any time during the measurement period
- G9994Patient is using palliative care services any time during the measurement period
- G9995Patients who use palliative care services any time during the measurement period
- G9996Documentation stating the patient has received or is currently receiving palliative or hospice care
- G9997Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
- G9998Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])
- G9999Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, patient cannot provide precise date or details from previous colonoscopy, previous colonoscopy report was incomplete)