Performance Measurement CPT Codes
Added January 2007

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Index

 
EMERGENCY ROOM
G0380 Level 1 hospital emergency visit provided in a Type B department or facility of the hospital: (the department or facility must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
G0381 Level 2 hospital emergency visit provided in a Type B department or facility of the hospital: (the department or facility must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
G0382 Level 3 hospital emergency visit provided in a Type B department or facility of the hospital: (the department or facility must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
G0383 Level 4 hospital emergency visit provided in a Type B department or facility of the hospital: (the department or facility must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
G0384 Level 5 hospital emergency visit provided in a Type B department or facility of the hospital: (the department or facility must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
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TRAUMA/VASCULAR
G0389 Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (AAA) screening
G0390 Trauma response team associated with hospital critical care service
G0392 Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; arterial
G0393 Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; venous
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GUAIAC TESTING
G0394 Blood occult test (e.g., guaiac), feces, for single determination for colorectal neoplasm (i.e. patient was provided three cards or single triple card for consecutive collection)
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SURGICAL INFECTION
G8191 Clinician documented to have given order for prophylactic antibiotic to be given within one hour (if vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)
G8192 Clinician documented to have given the prophylactic antibiotic within one hour (if vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required)
G8193 Clinician did not document that an order for prophylactic antibiotic to be given within one hour (if vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required) was given
G8194 Clinician documented that patient was not an eligible candidate for prophylactic antibiotic
G8195 Clinician documented to have given the prophylactic antibiotic within one hour (if vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required)
G8196 Clinician did not document a prophylactic antibiotic was administered within one hour (if vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)
G8197 Patient documented to have order for prophylactic antibiotic to be given within one hour (if vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)
G8198 Patient documented to have order for cefazolin or cefuroxime for antimicrobial prophylaxis
G8199 Clinician documented to have given cefazolin or cefuroxime for antimicrobial prophylaxis
G8200 Order for cefazolin or cefuroxime for antimicrobial prophylaxis not documented
G8201 Patient was not an eligible candidate for cefazolin or cefuroxime for antimicrobial prophylaxis
G8202 Clinician documented an order was given to discontinue prophylactic antibiotics within 24 hours of surgical end time
G8203 Clinician documented that prophylactic antibiotics were discontinued within 24 hours of surgical end time
G8204 Clinician did not document an order was given to discontinue prophylactic antibiotics within 24 hours of surgical end time
G8205 Clinician documented that patient was not an eligible candidate for prophylactic antibiotic discontinuation within 24 hours of surgical end time
G8206 Clinician documented that prophylactic antibiotic was given
G8207 Clinician documented an order was given to discontinue prophylactic antibiotics within 48 hours of surgical end time
G8208 Clinician documented that prophylactic antibiotics were discontinued within 48 hours of surgical end time
G8209 Clinician did not document an order was given to discontinue prophylactic antibiotics within 48 hours of surgical end time
G8210 Clinician documented patient was not an eligible candidate for discontinuation of prophylactic antibiotic discontinuation within 48 hours of surgical end time
G8211 Clinician documented that prophylactic antibiotic was given
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DVT PROPHYLAXIS
G8212 Clinician documented an order was given for appropriate venous thromboembolism (VTE) prophylaxis to be given within 24 hrs prior to incision time or 24 hours after surgery end time
G8213 Clinician documented to have given VTE prophylaxis within 24 hrs prior to incision time or 24 hours after surgery end time
G8214 Clinician did not document an order was given for appropriate venous thromboembolism (VTE) prophylaxis to be given within 24 hrs prior to incision time or 24 hours after surgery end time
G8215 Clinician documented that patient was not an eligible candidate for venous thromboembolism (VTE) prophylaxis to be given within 24 hours prior to incision time or 24 hours after surgery end time
G8216 Patient documented to have received DVT prophylaxis by end of hospital day two
G8217 Patient not documented to have received DVT prophylaxis by end of hospital day 2
G8218 Patient was not an eligible candidate for DVT prophylaxis by end of hospital day 2, including physician documentation that patient is ambulatory
G8219 Patient documented to have received DVT prophylaxis by end of hospital day 2
G8220 Patient not documented to have received DVT prophylaxis by end of hospital day 2
G8221 Clinician documented that patient was not an eligible candidate for DVT prophylaxis by the end of hospital day 2, including physician documentation that patient is ambulatory
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ANTIPLATELET/ANTICOAGULATION/LYTIC THERAPY
G8222 Patient documented to have been prescribed antiplatelet therapy at discharge
G8223 Patient not documented to have received prescription for antiplatelet therapy at discharge
G8224 Clinician documented that patient was not an eligible candidate for antiplatelet therapy at discharge, including identification from medical record that patient is on anticoagulation therapy
G8225 Patient documented to have been prescribed an anticoagulant at discharge
G8226 Patient not documented to have received prescription for anticoagulant therapy at discharge
G8227 Patient not documented to have permanent, persistent, or paroxysmal atrial fibrillation
G8228 Clinician documented that patient was not an eligible candidate for anticoagulant therapy at discharge
G8229 Patient documented to have been administered or considered for t-PA
G8230 Patient not eligible for t-PA administration, ischemic stroke symptom onset of more than 3 hours
G8231 Patient not documented to have received t-PA or not documented to have been considered a candidate for t-PA administration
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REHABILITATION SERVICES
G8237 Patient documented to have received order for rehabilitation services or documentation of consideration for rehabilitation services
G8238 Patient not documented to have received order for or consideration for rehabilitation services
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NEUROIMAGING/CAROTID STENOSIS
G8239 Internal carotid stenosis patient below 30%, reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement not necessary
G8240 Internal carotid stenosis patient in the 30-99% range, and no documentation of reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement
G8241 Clinician documented that patient whose final report of the carotid imaging study performed (neck MRA, neck CTA, neck duplex ultrasound, carotid angiogram), with characterization of an internal carotid stenosis in the 30-99% range, was not an eligible candidate for reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement
G8242 Patient documented to have received CT or MRI with presence or absence of hemorrhage, mass lesion and acute infarction documented in the final report
G8243 Patient not documented to have received CT or MRI and the presence or absence of hemorrhage, mass lesion and acute infarction not documented in the final report
G8245 Clinician documented presence or absence alarm symptoms
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GASTROENTEROLOGY/SWALLOWING
G8232 Patient documented to have received dysphagia screening prior to taking any foods, fluids or medication by mouth
G8234 Patient not documented to have received dysphagia screening
G8235 Patient not receiving or ineligible to receive food, fluids or medication by mouth, or documentation of NPO (nothing by mouth) order
G8236 Clinician documented that patient was not an eligible candidate for dysphagia screening prior to taking any foods, fluids or medication by mouth
G8247 Patient with alarm symptom(s) documented to have had upper endoscopy performed or referral for upper endoscopy
G8248 Patient with at least one alarm symptom not documented to have had upper endoscopy or referral for upper endoscopy
G8249 Clinician documented that patient was not an eligible candidate for upper endoscopy
G8250 Patient with suspicion of Barrett’s esophagus in endoscopy report and documented to have received an esophageal biopsy
G8251 Patient not documented to have received an esophageal biopsy when suspicion of Barrett’s esophagus is indicated in the endoscopy report
G8252 Clinician documented that patient was not an eligible candidate for esophageal biopsy
G8253 Patient documented to have received an order for a barium swallow test
G8254 Patient with no documentation order for barium swallow test
G8255 Clinician documentation that patient was an eligible candidate for barium swallow test
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MEDICATION RECONCILIATION
G8256 Clinician documented reconciliation of discharge medications with current medication list in medical record
G8257 Clinician has not documented reconciliation of discharge medications with current medication list in medical record
G8258 Patient was not an eligible candidate for discharge medications review
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SURROGATE DECISION MAKER/ADVANCED CARE PLAN
G8259 Patient documented to have surrogate decision maker or advance care plan in medical record
G8260 Patient not documented to have surrogate decision maker or advance care plan in medical record
G8261 Clinician documented that patient was not an eligible candidate for surrogate decision maker or advance care plan
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URINARY INCONTINENCE
G8262 Patient documented to have been assessed for presence or absence of urinary incontinence
G8263 Patient not documented to have been assessed for presence or absence of urinary incontinence
G8264 Clinician documented that patient was not an eligible candidate for an assessment of the presence or absence of urinary incontinence
G8265 Patient documented to have received characterization of urinary incontinence
G8266 Patient not documented to have received characterization of urinary incontinence
G8267 Patient documented to have received a plan of care for urinary incontinence
G8268 Patient not documented to have received plan of care for urinary incontinence
G8269 Clinician has not provided care for the patient for the required time to develop plan of care for urinary incontinence
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FALL RISK SCREENING
G8270 Patient documented to have received screening for fall risk (2 or more falls in the past year or any fall with injury in the past year)
G8271 Patient with no documentation of screening for fall risks (2 or more falls in the past year or any fall with injury in the past year)
G8272 Clinician documentation that patient was not an eligible candidate for fall risk screening
G8273 Clinician has not provided care for the patient for the required time to screen for fall risk
G8274 Clinician has not documented presence or absence of alarm symptoms
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DERMATOLOGY
G8246 Patient was not an eligible candidate for medical history review with assessment of new or changing moles
G8275 Patient documented to have medical history taken which included assessment of new or changing moles
G8276 Patient not documented to have received medical history with assessment of new or changing moles
G8277 Patient was not an eligible candidate for medical history review with assessment of new or changing moles
G8278 Patient documented to have received complete physical skin exam
G8279 Patient not documented to have received a complete physical skin exam
G8280 Patient was not an eligible candidate for complete physical skin exam during the reporting year
G8281 Patient documented to have received counseling to perform a self-examination
G8282 Patient not documented to have received counseling to perform a self-examination
G8283 Patient was not an eligible candidate for counseling to perform self-examination
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BONE/OSTEOPOROSIS
G8284 Patient documented to have received a prescription for pharmacologic therapy for osteoporosis
G8285 Patient not documented to have received pharmacologic therapy
G8286 Clinician documented that patient was not an eligible candidate for pharmacologic therapy
G8287 Clinician has not provided care for the patient for the required time for the pharmacologic therapy measure
G8288 Patient documented to have received calcium and vitamin d or counseling on both calcium and vitamin D use, and exercise
G8289 Patient with no documentation of calcium and vitamin D use or counseling regarding both calcium and vitamin D use, or exercise
G8290 Clinician documentation that patient was not an eligible candidate for calcium and vitamin D, and exercise during the reporting year
G8291 Clinician has not provided care for the patient for the required time for the calcium, vitamin D, and exercise measure
G8337 Clinician documented that communication was sent to the physician managing ongoing care of patient that a fracture occurred and that the patient was or should be tested or treated for osteoporosis
G8338 Clinician has not documented that communication was sent to the physician managing ongoing care of patient that a fracture occurred and that the patient was or should be tested or treated for osteoporosis
G8339 Patient was not an eligible candidate for communication with the physician managing the patient’s ongoing care that a fracture occurred and that the patient was or should be tested or treated for osteoporosis
G8340 Patient documented to have had central DEXA performed and results documented or central DEXA ordered or pharmacologic therapy prescribed
G8341 Patient not documented to have had central DEXA measurement or pharmacologic therapy
G8342 Clinician documented that patient was not an eligible candidate for central DEXA measurement or prescribing pharmacologic
G8343 Clinician has not provided care for the patient for the required time for central DEXA measurement or pharmacological therapy measure
G8344 Patient documented to have had central DEXA ordered or performed and results documented or pharmacological therapy prescribed
G8345 Patient not documented to have had central DEXA measurement ordered or performed or pharmacologic therapy
G8346 Clinician documented that patient was not an eligible candidate for central DEXA measurement or pharmacologic therapy
G8347 Clinician has not provided care for the patient for the required time for central DEXA measurement or pharmacological therapy measure
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COPD
G8292 COPD patient with spirometry results documented
G8293 COPD patient without spirometry results documented
G8294 COPD patient was not eligible for spirometry results
G8295 COPD patient documented to have received inhaled bronchodilator therapy
G8296 COPD patient not documented to have inhaled bronchodilator therapy prescribed
G8297 COPD patient was not eligible for inhaled bronchodilator therapy
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VITAMIN/MINERAL/ANTIOXIDANT THERAPY
G8309 Patient documented to have been prescribed/recommended antioxidant vitamin or mineral supplement
G8310 Patient not documented to have been prescribed/recommended at least one antioxidant vitamin or mineral supplement during the reporting year
G8311 Clinician documentation that patient was not an eligible candidate for antioxidant vitamin or mineral supplement during the reporting year
G8312 Clinician has not provided care for the age-related macular degeneration patient for the required time for antioxidant supplement prescription/recommended measure
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OPHTHALMOLOGY/DIABETIC RETINOPATHY
G8298 Patient documented to have received optic nerve head evaluation
G8299 Patient not documented to have received optic nerve head evaluation
G8300 Clinician documented that patient was not an eligible candidate for optic nerve head evaluation during the reporting year
G8301 Clinician has not provided care for the primary open-angle glaucoma patient for the required time for optic nerve head evaluation measure
G8302 Patient documented to have a specific target intraocular pressure range goal
G8303 Patient not documented to have a specific target intraocular pressure range goal
G8304 Clinician documented that patient was not an eligible candidate for a specific target intraocular pressure range goal
G8305 Clinician has not provided care for the primary open-angle glaucoma patient for the required time for treatment range goal documentation measurement
G8306 Primary open-angle glaucoma patient with intraocular pressure above the target range goal documented to have received plan of care
G8307 Primary open-angle glaucoma patient with intraocular pressure at or below goal, no plan of care necessary
G8308 Primary open-angle glaucoma patient with intraocular pressure above the target range goal, and not documented to have received plan of care during the reporting year
G8313 Patient documented to have received macular exam, including documentation of the presence or absence of macular thickening or hemorrhage and the level of macular degeneration severity
G8314 Patient not documented to have received macular exam with documentation of presence or absence of macular thickening or hemorrhage and no documentation of level of macular degeneration severity
G8315 Clinician documentation that patient was not an eligible candidate for macular examination during the reporting year
G8316 Clinician has not provided care for the age-related macular degeneration patient for the required time for macular examination measurement
G8317 Patient documented to have visual functional status assessed
G8318 Patient documented not to have visual functional status assessed
G8319 Clinician documented that patient was not an eligible candidate for assessment of visual functional status
G8320 Clinician has not provided care for the cataract patient for the required time for assessment of visual functional status measurement
G8321 Patient documented to have had pre-surgical axial length, corneal power measurement and method of intraocular lens power calculation
G8322 Patient not documented to have had pre-surgical axial length, corneal power measurement and method of intraocular lens power calculation
G8323 Clinician documentation that patient was not an eligible candidate for pre-surgical axial length, corneal power measurement and method of intraocular lens power calculation
G8324 Clinician has not provided care for the cataract patient for the required time for pre-surgical measurement and intraocular lens power calculation measure
G8325 Patient documented to have received fundus evaluation within six months prior to cataract surgery
G8326 Patient not documented to have received fundus evaluation within six months prior to cataract surgery
G8327 Patient was not an eligible candidate for pre-surgical fundus evaluation
G8328 Clinician has not provided care for the cataract patient for the required time for fundus evaluation measurement
G8329 Patient documented to have received dilated macular or fundus exam with level of severity of retinopathy and the presence or absence of macular edema documented
G8330 Patient not documented to have received dilated macular or fundus exam with level of severity of retinopathy and the presence or absence of macular edema not documented
G8331 Clinician documentation that patient was not an eligible candidate for dilated macular or fundus exam during the reporting year
G8332 Clinician has not provided care for the diabetic retinopathy patient for the required time for macular edema and retinopathy measurement
G8333 Patient documented to have had findings of macular or fundus exam communicated to the physician managing the diabetes care
G8334 Documentation of findings of macular or fundus exam not communicated to the physician managing the patient’s ongoing diabetes care
G8335 Clinician documentation that patient was not an eligible candidate for the findings of their macular or fundus exam being communicated to the physician managing their diabetes care during the reporting year
G8336 Clinician has not provided care for the diabetic retinopathy patient for the required time for physician communication measurement
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