List of HCPCS codes for: Temporary Procedures & Professional Services (G-codes) - Group G9

HCPCS Code	Short Description	Long Description
G9	Mac for at risk patient	Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition
G9001	Mccd, initial rate	Coordinated care fee, initial rate
G9002	Mccd,maintenance rate	Coordinated care fee, maintenance rate
G9003	Mccd, risk adj hi, initial	Coordinated care fee, risk adjusted high, initial
G9004	Mccd, risk adj lo, initial	Coordinated care fee, risk adjusted low, initial
G9005	Mccd, risk adj, maintenance	Coordinated care fee, risk adjusted maintenance
G9006	Mccd, home monitoring	Coordinated care fee, home monitoring
G9007	Mccd, sch team conf	Coordinated care fee, scheduled team conference
G9008	Mccd,phys coor-care ovrsght	Coordinated care fee, physician coordinated care oversight services
G9009	Mccd, risk adj, level 3	Coordinated care fee, risk adjusted maintenance, level 3
G9010	Mccd, risk adj, level 4	Coordinated care fee, risk adjusted maintenance, level 4
G9011	Mccd, risk adj, level 5	Coordinated care fee, risk adjusted maintenance, level 5
G9012	Other specified case mgmt	Other specified case management service not elsewhere classified
G9013	Esrd demo bundle level i	Esrd demo basic bundle level i
G9014	Esrd demo bundle-level ii	Esrd demo expanded bundle including venous access and related services
G9016	Demo-smoking cessation coun	Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only]
G9017	Amantadine hcl 100mg oral	Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
G9018	Zanamivir,inhalation pwd 10m	Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project)
G9019	Oseltamivir phosphate 75mg	Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project)
G9020	Rimantadine hcl 100mg oral	Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)
G9033	Amantadine hcl oral brand	Amantadine hydrochloride, oral brand, per 100 mg (for use in a medicare-approved demonstration project)
G9034	Zanamivir, inh pwdr, brand	Zanamivir, inhalation powder, administered through inhaler, brand, per 10 mg (for use in a medicare-approved demonstration project)
G9035	Oseltamivir phosp, brand	Oseltamivir phosphate, oral, brand, per 75 mg (for use in a medicare-approved demonstration project)
G9036	Rimantadine hcl, brand	Rimantadine hydrochloride, oral, brand, per 100 mg (for use in a medicare-approved demonstration project)
G9037	Intrpro req fr rec phys/qhcp	Interprofessional 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
G9038	Co-management services	Co-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
G9050	Oncology work-up evaluation	Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence (for use in a medicare-approved demonstration project)
G9051	Oncology tx decision-mgmt	Oncology; primary focus of visit; treatment decision-making after disease is staged or restaged, discussion of treatment options, supervising/coordinating active cancer directed therapy or managing consequences of cancer directed therapy (for use in a medicare-approved demonstration project)
G9052	Onc surveillance for disease	Oncology; primary focus of visit; surveillance for disease recurrence for patient who has completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
G9053	Onc expectant management pt	Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered or arranged at present; cancer directed therapy might be considered in the future (for use in a medicare-approved demonstration project)
G9054	Onc supervision palliative	Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a medicare-approved demonstration project)
G9055	Onc visit unspecified nos	Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a medicare-approved demonstration project)
G9056	Onc prac mgmt adheres guide	Oncology; practice guidelines; management adheres to guidelines (for use in a medicare-approved demonstration project)
G9057	Onc pract mgmt differs trial	Oncology; practice guidelines; management differs from guidelines as a result of patient enrollment in an institutional review board approved clinical trial (for use in a medicare-approved demonstration project)
G9058	Onc prac mgmt disagree w/gui	Oncology; practice guidelines; management differs from guidelines because the treating physician disagrees with guideline recommendations (for use in a medicare-approved demonstration project)
G9059	Onc prac mgmt pt opt alterna	Oncology; practice guidelines; management differs from guidelines because the patient, after being offered treatment consistent with guidelines, has opted for alternative treatment or management, including no treatment (for use in a medicare-approved demonstration project)
G9060	Onc prac mgmt dif pt comorb	Oncology; practice guidelines; management differs from guidelines for reason(s) associated with patient comorbid illness or performance status not factored into guidelines (for use in a medicare-approved demonstration project)
G9061	Onc prac cond noadd by guide	Oncology; practice guidelines; patient's condition not addressed by available guidelines (for use in a medicare-approved demonstration project)
G9062	Onc prac guide differs nos	Oncology; practice guidelines; management differs from guidelines for other reason(s) not listed (for use in a medicare-approved demonstration project)
G9063	Onc dx nsclc stgi no progres	Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage i (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9064	Onc dx nsclc stg2 no progres	Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage ii (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9065	Onc dx nsclc stg3a no progre	Oncology; disease status; limited to non-small cell lung cancer; extent of disease initially established as stage iii a (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9066	Onc dx nsclc stg3b-4 metasta	Oncology; disease status; limited to non-small cell lung cancer; stage iii b- iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
G9067	Onc dx nsclc dx unknown nos	Oncology; disease status; limited to non-small cell lung cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9068	Onc dx sclc/nsclc limited	Oncology; disease status; limited to small cell and combined small cell/non-small cell; extent of disease initially established as limited with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9069	Onc dx sclc/nsclc ext at dx	Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small cell; extensive stage at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
G9070	Onc dx sclc/nsclc ext unknwn	Oncology; disease status; small cell lung cancer, limited to small cell and combined small cell/non-small; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9071	Onc dx brst stg1-2b hr,nopro	Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9072	Onc dx brst stg1-2 noprogres	Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9073	Onc dx brst stg3-hr, no pro	Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9074	Onc dx brst stg3-noprogress	Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9075	Onc dx brst metastic/ recur	Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
G9077	Onc dx prostate t1no progres	Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9078	Onc dx prostate t2no progres	Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9079	Onc dx prostate t3b-t4noprog	Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9080	Onc dx prostate w/rise psa	Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project)
G9083	Onc dx prostate unknwn nos	Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9084	Onc dx colon t1-3,n1-2,no pr	Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9085	Onc dx colon t4, n0 w/o prog	Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, n0, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9086	Onc dx colon t1-4 no dx prog	Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-4, n1-2, m0 with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9087	Onc dx colon metas evid dx	Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive with current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
G9088	Onc dx colon metas noevid dx	Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive without current clinical, radiologic, or biochemical evidence of disease (for use in a medicare-approved demonstration project)
G9089	Onc dx colon extent unknown	Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9090	Onc dx rectal t1-2 no progr	Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9091	Onc dx rectal t3 n0 no prog	Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9092	Onc dx rectal t1-3,n1-2noprg	Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence or metastases (for use in a medicare-approved demonstration project)
G9093	Onc dx rectal t4,n,m0 no prg	Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9094	Onc dx rectal m1 w/mets prog	Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
G9095	Onc dx rectal extent unknwn	Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9096	Onc dx esophag t1-t3 noprog	Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9097	Onc dx esophageal t4 no prog	Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease initially established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9098	Onc dx esophageal mets recur	Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
G9099	Onc dx esophageal unknown	Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9100	Onc dx gastric no recurrence	Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r0 resection (with or without neoadjuvant therapy) with no evidence of disease recurrence, progression, or metastases (for use in a medicare-approved demonstration project)
G9101	Onc dx gastric p r1-r2noprog	Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; post r1 or r2 resection (with or without neoadjuvant therapy) with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
G9102	Onc dx gastric unresectable	Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m0, unresectable with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
G9103	Onc dx gastric recurrent	Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
G9104	Onc dx gastric unknown nos	Oncology; disease status; gastric cancer, limited to adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9105	Onc dx pancreatc p r0 res no	Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9106	Onc dx pancreatc p r1/r2 no	Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 or r2 resection with no evidence of disease progression, or metastases (for use in a medicare-approved demonstration project)
G9107	Onc dx pancreatic unresectab	Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
G9108	Onc dx pancreatic unknwn nos	Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9109	Onc dx head/neck t1-t2no prg	Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9110	Onc dx head/neck t3-4 noprog	Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9111	Onc dx head/neck m1 mets rec	Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)
G9112	Onc dx head/neck ext unknown	Oncology; disease status; head and neck cancer, limited to cancers of oral cavity, pharynx and larynx with squamous cell as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9113	Onc dx ovarian stg1a-b no pr	Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 1) without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9114	Onc dx ovarian stg1a-b or 2	Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii; without evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9115	Onc dx ovarian stg3/4 noprog	Oncology; disease status; ovarian cancer, limited to epithelial cancer; pathologic stage iii-iv; without evidence of progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9116	Onc dx ovarian recurrence	Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project)
G9117	Onc dx ovarian unknown nos	Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9123	Onc dx cml chronic phase	Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; chronic phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
G9124	Onc dx cml acceler phase	Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; accelerated phase not in hematologic cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
G9125	Onc dx cml blast phase	Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; blast phase not in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
G9126	Onc dx cml remission	Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or molecular remission (for use in a medicare-approved demonstration project)
G9128	Onc dx multi myeloma stage i	Oncology; disease status; limited to multiple myeloma, systemic disease; smoldering, stage i (for use in a medicare-approved demonstration project)
G9129	Onc dx mult myeloma stg2 hig	Oncology; disease status; limited to multiple myeloma, systemic disease; stage ii or higher (for use in a medicare-approved demonstration project)
G9130	Onc dx multi myeloma unknown	Oncology; disease status; limited to multiple myeloma, systemic disease; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9131	Onc dx brst unknown nos	Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a medicare-approved demonstration project)
G9132	Onc dx prostate mets no cast	Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen therapy or post-orchiectomy); clinical metastases (for use in a medicare-approved demonstration project)
G9133	Onc dx prostate clinical met	Oncology; disease status; prostate cancer, limited to adenocarcinoma; hormone-responsive; clinical metastases or m1 at diagnosis (for use in a medicare-approved demonstration project)
G9134	Onc nhlstg 1-2 no relap no	Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage i, ii at diagnosis, not relapsed, not refractory (for use in a medicare-approved demonstration project)
G9135	Onc dx nhl stg 3-4 not relap	Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; stage iii, iv, not relapsed, not refractory (for use in a medicare-approved demonstration project)
G9136	Onc dx nhl trans to lg bcell	Oncology; disease status; non-hodgkin's lymphoma, transformed from original cellular diagnosis to a second cellular classification (for use in a medicare-approved demonstration project)
G9137	Onc dx nhl relapse/refractor	Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; relapsed/refractory (for use in a medicare-approved demonstration project)
G9138	Onc dx nhl stg unknown	Oncology; disease status; non-hodgkin's lymphoma, any cellular classification; diagnostic evaluation, stage not determined, evaluation of possible relapse or non-response to therapy, or not listed (for use in a medicare-approved demonstration project)
G9139	Onc dx cml dx status unknown	Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia chromosome positive and/or bcr-abl positive; extent of disease unknown, staging in progress, not listed (for use in a medicare-approved demonstration project)
G9140	Frontier extended stay demo	Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours
G9143	Warfarin respon genetic test	Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
G9147	Outpt iv insulin tx any mea	Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration
G9148	Medical home level 1	National committee for quality assurance - level 1 medical home
G9149	Medical home level ii	National committee for quality assurance - level 2 medical home
G9150	Medical home level iii	National committee for quality assurance - level 3 medical home
G9151	Mapcp demo state	Mapcp demonstration - state provided services
G9152	Mapcp demo community	Mapcp demonstration - community health teams
G9153	Mapcp demo physician	Mapcp demonstration - physician incentive pool
G9156	Evaluation for wheelchair	Evaluation for wheelchair requiring face to face visit with physician
G9157	Transesoph doppl cardiac mon	Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes
G9158	Motor speech d/c status	Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
G9159	Lang comp current status	Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals
G9160	Lang comp goal status	Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9161	Lang comp d/c status	Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
G9162	Lang express current status	Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals
G9163	Lang express goal status	Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9164	Lang express d/c status	Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting
G9165	Atten current status	Attention functional limitation, current status at therapy episode outset and at reporting intervals
G9166	Atten goal status	Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9167	Atten d/c status	Attention functional limitation, discharge status at discharge from therapy or to end reporting
G9168	Memory current status	Memory functional limitation, current status at therapy episode outset and at reporting intervals
G9169	Memory goal status	Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9170	Memory d/c status	Memory functional limitation, discharge status at discharge from therapy or to end reporting
G9171	Voice current status	Voice functional limitation, current status at therapy episode outset and at reporting intervals
G9172	Voice goal status	Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9173	Voice d/c status	Voice functional limitation, discharge status at discharge from therapy or to end reporting
G9174	Speech lang current status	Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals
G9175	Speech lang goal status	Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9176	Speech lang d/c status	Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting
G9186	Motor speech goal status	Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9187	Bpci home visit	Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code
G9188	Beta not given no reason	Beta-blocker therapy not prescribed, reason not given
G9189	Beta pres or already taking	Beta-blocker therapy prescribed or currently being taken
G9190	Medical reason for no beta	Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons)
G9191	Pt reason for no beta	Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons)
G9192	System reason for no beta	Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)
G9193	Doc not eligible for dep med	Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression
G9194	Mdd pt treated for 180d	Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase
G9195	Mdd pt not treated for 180d	Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase
G9196	Med reason for no ceph	Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))
G9197	Order for ceph	Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis
G9198	No order for ceph no reason	Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given
G9199	Doc reason for no vte	Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s))
G9200	No reason for no vte	Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given
G9201	Vte given upon admission	Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission
G9202	Hep c aby pos	Patients with a positive hepatitis c antibody test
G9203	Hep c rna done prior to med	Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
G9204	No reason for no hep c rna	Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
G9205	Hep c antiviral started	Patient starting antiviral treatmentfor hepatitis c during the measurement period
G9206	Hep c therapy started	Patient starting antiviral treatment for hepatitis c during the measurement period
G9207	Hep c genotype prior to med	Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
G9208	No reason for no hep c geno	Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
G9209	Hep c rna 4to12 wk after med	Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment
G9210	No hepc rna after med docrsn	Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons)
G9211	No hepc rna after med no rsn	Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given
G9212	Doc of dsm-iv init eval	Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
G9213	No doc of dsm-iv	Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
G9214	Cd4 count documented	Cd4+ cell count or cd4+ cell percentage results documented
G9215	No cd4 count no reason	Cd4+ cell count or percentage not documented as performed, reason not given
G9216	No pcp proph at dx no reason	Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
G9217	No pcp proph low cd4 norsn	Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given
G9218	No pcp prop low at cd4 norsn	Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given
G9219	No oder pjp for med reason	Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
G9220	No order for pjp for medrsn	Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
G9221	Pjp proph prescribed	Pneumocystis jiroveci pneumonia prophlaxis prescribed
G9222	Pjp proph ordered low cd4	Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3
G9223	Pjp proph ordered cd4 low	Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
G9224	Medrsn no foot exam	Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)
G9225	Norsn no foot exam	Foot exam was not performed, reason not given
G9226	3 comp foot exam completed	Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed)
G9227	Foa doc, care plan not doc	Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter
G9228	Gc chl syp documented	Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings)
G9229	Ptrsn no gc chl syp test	Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception)
G9230	Norsn for gc chl syp test	Chlamydia, gonorrhea, and syphilis not screened, reason not given
G9231	Doc esrd dia trans preg	Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period
G9232	Ptrsn no comm comorbid	Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason (e.g., patient is unable to communicate the diagnosis of a comorbid condition; the patient is unwilling to communicate the diagnosis of a comorbid condition; or the patient is unaware of the comorbid condition, or any other specified patient reason)
G9233	Tkr composite	All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient
G9234	Tkr intent	I intend to report the total knee replacement measures group
G9235	Gs mg composite	All quality actions for the applicable measures in the general surgery measures group have been performed for this patient
G9236	Op rad mg composite	All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient
G9237	Gs mg intent	I intend to report the general surgery measures group
G9238	Op rad mg intent	I intend to report the optimizing patient exposure to ionizing radiation measures group
G9239	Doc rsn hemod & cath acc	Documentation 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)
G9240	Doc pt w cath maint dia	Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated
G9241	Doc pt w out cath maint dia	Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated
G9242	Doc viral load >=200	Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
G9243	Doc viral load <200	Documentation of viral load less than 200 copies/ml
G9244	Antiviral not ordered	Antiretroviral thereapy not prescribed
G9245	Antiviral ordered	Antiretroviral therapy prescribed
G9246	No med visit in 24mo	Patient did not have at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits
G9247	1 med visit in 24mo	Patient had at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits
G9248	No med visit 6mo	Patient did not have a medical visit in the last 6 months
G9249	Med visit w in 6mo	Patient had a medical visit in the last 6 months
G9250	Doc of pain comfort 48hr	Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment
G9251	Doc no pain comfort 48hr	Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment
G9252	Neo detect scrn colo	Adenoma(s) or other neoplasm detected during screening colonoscopy
G9253	No neo detect scrn colo	Adenoma(s) or other neoplasm not detected during screening colonoscopy
G9254	Doc pt dischg >2d	Documentation of patient discharged to home later than post-operative day 2 following cas
G9255	Doc pt dischg <=2d	Documentation of patient discharged to home no later than post operative day 2 following cas
G9256	Doc of pat death after cas	Documentation of patient death following cas
G9257	Doc of pat stroke after cas	Documentation of patient stroke following cas
G9258	Doc of pat stroke after cea	Documentation of patient stroke following cea
G9259	Survive/no stroke post cas	Documentation of patient survival and absence of stroke following cas
G9260	Doc of pat death after cea	Documentation of patient death following cea
G9261	Survive/no stroke post cea	Documentation of patient survival and absence of stroke following cea
G9262	Doc of death post-aaa repair	Documentation of patient death in the hospital following endovascular aaa repair
G9263	Doc of disch post-aaa repair	Documentation of patient discharged alive following endovascular aaa repair
G9264	Doc rsn hemod w/cath >=90d	Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons)
G9265	Doc cath >90d for maint dia	Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access
G9266	Norsn pt cath >=90d	Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access
G9267	Doc comp or mort w in 30d	Documentation of patient with one or more complications or mortality within 30 days
G9268	Doc comp or mort w in 90d	Documentation of patient with one or more complications within 90 days
G9269	Doc no comp or mort w in 30d	Documentation of patient without one or more complications and without mortality within 30 days
G9270	Doc no comp or mort w in 90d	Documentation of patient without one or more complications within 90 days
G9271	Ldl under 100	Ldl value < 100
G9272	Ldl 100 and over	Ldl value >= 100
G9273	Sys<140 and dia<90	Blood pressure has a systolic value of < 140 and a diastolic value of < 90
G9274	Bp out of nrml limits	Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90
G9275	Doc of non tobacco user	Documentation that patient is a current non-tobacco user
G9276	Doc of tobacco user	Documentation that patient is a current tobacco user
G9277	Doc daily aspirin or contra	Documentation that the patient is on daily aspirin or anti-platelet or has documentation of a valid contraindication or exception to aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use, allergy to aspirin or anti-platelets, history of gastrointestinal bleed and bleeding disorder; additionally, the following exceptions documented by the physician as a reason for not taking daily aspirin or anti-platelet are acceptable (use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension defined as >180 systolic or >110 diastolic or gastroesophageal reflux)
G9278	Doc no daily aspirin	Documentation that the patient is not on daily aspirin or anti-platelet regimen
G9279	Pne scrn done doc vac done	Pneumococcal screening performed and documentation of vaccination received prior to discharge
G9280	Pne not given norsn	Pneumococcal vaccination not administered prior to discharge, reason not specified
G9281	Pne scrn done doc not ind	Screening performed and documentation that vaccination not indicated/patient refusal
G9282	Doc medrsn no histo type	Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons)
G9283	Hist type doc on report	Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
G9284	No hist type doc on report	Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation
G9285	Site not small cell lung ca	Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer
G9286	Antibio rx w in 10d of sympt	Antibiotic regimen prescribed within 10 days after onset of symptoms
G9287	No antibio w in 10d of sympt	Antibiotic regimen not prescribed within 10 days after onset of symptoms
G9288	Doc medrsn no hist type rpt	Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons)
G9289	Doc type nsm lung ca	Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation
G9290	No doc type nsm lung ca	Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation
G9291	Not nsm lung ca	Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos
G9292	Medrsn no pt category	Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons)
G9293	No pt category on report	Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
G9294	Pt cat and thck on report	Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate
G9295	Non cutaneous loc	Specimen site other than anatomic cutaneous location
G9296	Doc share dec prior proc	Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure
G9297	No doc share dec prior proc	Shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedure, not documented, reason not given
G9298	Eval risk vte card 30d prior	Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke)
G9299	No eval risk vte card prior	Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi, arrhythmia and stroke, reason not given)
G9300	Doc medrsn no compl antibio	Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used)
G9301	Doc compl inf antibio	Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet
G9302	Norsn incomp inf antibio	Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given
G9303	Norsn no pros info op rpt	Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant, reason not given
G9304	Pros info op rpt	Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of each prosthetic implant
G9305	No interv req for leak	Intervention for presence of leak of endoluminal contents through an anastomosis not required
G9306	Interv req for leak	Intervention for presence of leak of endoluminal contents through an anastomosis required
G9307	No ret for surg w in 30d	No return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
G9308	Unpl ret or w/compl w/in 30d	Unplanned return to the operating room for a surgical procedure, for complications of the principal operative procedure, within 30 days of the principal operative procedure
G9309	No unplnd hosp readm in 30d	No unplanned hospital readmission within 30 days of principal procedure
G9310	Unplnd hosp readm in 30d	Unplanned hospital readmission within 30 days of principal procedure
G9311	No surg site infection	No surgical site infection
G9312	Surgical site infection	Surgical site infection
G9313	Amoxic not presc as 1st line	Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason
G9314	Norsn not first line amox	Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given
G9315	Amox w/wo clav rx	Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis
G9316	Doc comm risk calc	Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family
G9317	No doc comm risk calc	Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed
G9318	Image std nomenclature	Imaging study named according to standardized nomenclature
G9319	Image not std nomenclature	Imaging study not named according to standardized nomenclature, reason not given
G9320	Medrsn no std nomenclature	Documentation of medical reason(s) for not naming ct studies according to a standardized nomenclature provided (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
G9321	Doc count of ct in 12mo	Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion) studies documented in the 12-month period prior to the current study
G9322	No doc count of ct in 12mo	Count of previous ct and cardiac nuclear medicine (myocardial perfusion) studies not documented in the 12-month period prior to the current study, reason not given
G9323	Mdrsn no doc cnt of ct	Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
G9324	Not all data norsn	All necessary data elements not included, reason not given
G9325	Medrsn no ct rpt to reg	Ct studies not reported to a radiation dose index registry due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
G9326	Ct done no rad ds index, nrg	Ct studies performed not reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements, reason not given
G9327	Ct done rad ds index	Ct studies performed reported to a radiation dose index registry that is capable of collecting at a minimum all necessary data elements
G9328	Medrsn no dicom format doc	Dicom format image data availability not documented in final report due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
G9329	Norsn no dicom format doc	Dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given
G9340	Dicom format doc on rpt	Final report documented that dicom format image data available to non-affiliated external healthcare facilities or entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study
G9341	Srch for ct w in 12 mos	Search conducted for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed
G9342	No srch for ct in 12mo norsn	Search not conducted prior to an imaging study being performed for prior patient ct studies completed at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media-free, shared archive, reason not given
G9343	Medrsn no dicom srch	Due to medical reasons, search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
G9344	Sysrsn no dicom srch	Due to system reasons search not conducted for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., non-affiliated external healthcare facilities or entities does not have archival abilities through a shared archival system)
G9345	Follow up pulm nod	Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors
G9346	No follow up pulm nod	Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery)
G9347	No follow up pulm nod norsn	Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given
G9348	Doc rsn for ord ct scan	Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons
G9349	Ct within 28 days	Ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis
G9350	No doc sinus ct 28d or dx	Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis
G9351	Doc >1 sinus ct w 90d dx	More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis
G9352	Not >1 sinus ct w 90d dx	More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given
G9353	Medrsn >1 sinus ct w 90d dx	More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with complications, second ct obtained prior to surgery, other medical reasons)
G9354	1 or no ct sinus w/in 90d dx	One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after the date of diagnosis
G9355	No early ind/delivery	Elective delivery (without medical indication) by cesarean birth or induction of labor not performed (<39 weeks of gestation)
G9356	Early ind/delivery	Elective delivery (without medical indication) by cesarean birth or induction of labor performed (<39 weeks of gestation)
G9357	Pp eval/edu perf	Post-partum screenings, evaluations and education performed
G9358	Pp eval/edu not perf	Post-partum screenings, evaluations and education not performed
G9359	Neg mgd pos tb notact	Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier
G9360	No doc of neg or man pos tb	No documentation of negative or managed positive tb screen
G9361	Doc rsn elect c-sec/induct	Medical indication for delivery by cesarean birth or induction of labor (<39 weeks of gestation) [documentation of reason(s) for elective delivery (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)]
G9362	Mac or pnb w/o genanes >60m	Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record
G9363	Mac or pnb w/o genanes <60m	Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb) without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record
G9364	Sinus caus bac inx	Sinusitis caused by, or presumed to be caused by, bacterial infection
G9365	1high risk med ord	One high-risk medication ordered
G9366	1high risk no ord	One high-risk medication not ordered
G9367	>= 2 same hi-rsk med ord	At least two orders for high-risk medications from the same drug class
G9368	>= 2 same hi-rsk med not ord	At least two orders for high-risk medications from the same drug class not ordered
G9369	Fill 2 rx antipsych	Individual filled at least two prescriptions for any antipsychotic medication and had a pdc of 0.8 or greater
G9370	Not fill 2 rx antipsych	Individual who did not fill at least two prescriptions for any antipsychotic medication or did not have a pdc of 0.8 or greater
G9376	Contd ret attach at 6mth f/u	Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month) following only one surgery
G9377	No ret attach after 6mt	Patient did not have the retina attached after 6 months following only one surgery
G9378	Contd ret attach f/u vis	Patient continued to have the retina attached at the 6 months follow up visit (+/- 1 month)
G9379	No acheive flat ret 6mth	Patient did not achieve flat retinas six months post surgery
G9380	Off assis eol iss	Patient offered assistance with end of life issues or existing end of life plan was reviewed or updated during the measurement period
G9381	Doc med reas no offer eol	Documentation of medical reason(s) for not offering assistance with end of life issues (e.g., patient in hospice care, patient in terminal phase) during the measurement period
G9382	No off assis eol	Patient not offered assistance with end of life issues or existing end of life plan was not reviewed or updated during the measurement period
G9383	Recd scrn hcv infec	Patient received screening for hcv infection within the 12 month reporting period
G9384	Doc med rsn no hcv scrn	Documentation of medical reason(s) for not receiving annual screening for hcv infection (e.g., decompensated cirrhosis indicating advanced disease [i.e., ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular carcinoma, waitlist for organ transplant, limited life expectancy, other medical reasons)
G9385	Doc pt reas not rec hcv srn	Documentation of patient reason(s) for not receiving annual screening for hcv infection (e.g., patient declined, other patient reasons)
G9386	Scrn hcv infec not recd	Screening for hcv infection not received within the 12 month reporting period, reason not given
G9389	Unpln rup post cap	Unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
G9390	No unpln rup post cap	No unplanned rupture of the posterior capsule requiring vitrectomy during cataract surgery
G9391	Achv refrac +1d	Patient achieves refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
G9392	Not achv refrac +1d	Patient does not achieve refraction +-1 d for the eye that underwent cataract surgery, measured at the one month follow up visit
G9393	Ini phq9 >9 remiss <5	Patient with an initial phq-9 score greater than nine who achieves remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of less than five
G9394	Dx bipol, death, nhres, hosp	Patient who had a diagnosis of bipolar disorder or personality disorder, death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement or assessment period
G9395	Ini phq9 >9 no remiss >=5	Patient with an initial phq-9 score greater than nine who did not achieve remission at twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score greater than or equal to five
G9396	Ini phq9 >9 not assess	Patient with an initial phq-9 score greater than nine who was not assessed for remission at twelve months (+/- 30 days)
G9399	Doc disc tx choices	Documentation in the patient record of a discussion between the physician/clinician and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment
G9400	Doc reas no disc tx opt	Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons
G9401	No disc tx choices	No 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
G9402	Recd f/u w/in 30d disch	Patient received follow-up within 30 days after discharge
G9403	Doc reas no 30 day f/u	Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up)
G9404	No 30 day f/u	Patient did not receive follow-up within 30 days after discharge
G9405	Recd f/u w/in 7d dc	Patient received follow-up within 7 days after discharge
G9406	Doc reas no 7d f/u	Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up)
G9407	No 7d f/u	Patient did not receive follow-up within 7 days after discharge
G9408	Card tamp w/in 30d	Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days
G9409	No card tamp e/in 30d	Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days
G9410	Admit w/in 180d req remov	Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
G9411	No admit w/in 180d req remov	Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
G9412	Admit w/in 180d req surg rev	Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
G9413	No admit req surg rev	Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
G9414	1dose menig vac btwn 11 & 13	Patient had one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient's 11th and 13th birthdays
G9415	No 1dose meni vac btwn 11&13	Patient did not have one dose of meningococcal vaccine (serogroups a, c, w, y) on or between the patient's 11th and 13th birthdays
G9416	Pt 1 tdap betw 10-13 yrs	Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays
G9417	Pt not 1 tdap betw 10-13 yrs	Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (tdap) on or between the patient's 10th and 13th birthdays
G9418	Lungcx bx rpt docs class	Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following iaslc guidance or classified as nsclc-nos with an explanation
G9419	Med reas not incl histo type	Documentation of medical reason(s) for not including the histological type or nsclc-nos classification with an explanation (e.g. specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons)
G9420	Spec site no lung	Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer
G9421	Lung cx bx rpt no doc class	Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type or histologic type does not follow iaslc guidance or is classified as nsclc-nos but without an explanation
G9422	Rpt doc class histo type	Primary lung carcinoma resection report documents pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma and not nsclc-nos)
G9423	Med reas rpt no histo type	Documentation of medical reason for not including pt category, pn category and histologic type [for patient with appropriate exclusion criteria (e.g., metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)]
G9424	Site no lung or lung cx	Specimen site other than anatomic location of lung, or classified as nsclc-nos
G9425	Spec rpt no doc class histo	Primary lung carcinoma resection report does not document pt category, pn category and for non-small cell lung cancer, histologic type (e.g., squamous cell carcinoma, adenocarcinoma)
G9426	Impr med time edarr pain med	Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration performed for ed admitted patients
G9427	No impro med time pain med	Improvement in median time from ed arrival to initial ed oral or parenteral pain medication administration not performed for ed admitted patients
G9428	Patho rpt incl pt ctg	Pathology report includes the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
G9429	Doc med rsn no pt cat	Documentation of medical reason(s) for not including pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors (e.g., negative skin biopsies, insufficient tissue, or other documented medical reasons)
G9430	Spec site no cutaneous	Specimen site other than anatomic cutaneous location
G9431	Patho rpt no pt ctg	Pathology report does not include the pt category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors
G9432	Asth controlled	Asthma well-controlled based on the act, c-act, acq, or ataq score and results documented
G9433	Death, nhres, hospice	Death, permanent nursing home resident or receiving hospice or palliative care any time during the measurement period
G9434	Asth not controlled	Asthma not well-controlled based on the act, c-act, acq, or ataq score, or specified asthma control tool not used, reason not given
G9435	Asp presc disch	Aspirin prescribed at discharge
G9436	Asp not presc doc reas	Aspirin not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
G9437	Asp not presc disch	Aspirin not prescribed at discharge
G9438	P2y inhib presc	P2y inhibitor prescribed at discharge
G9439	P2y inhib not presc doc reas	P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical intolerance, history of bleed)
G9440	P2y inhib not presc	P2y inhibitor not prescribed at discharge
G9441	Statin presc disch	Statin prescribed at discharge
G9442	Statin not presc doc reas	Statin not prescribed for documented reasons (e.g., allergy, medical intolerance)
G9443	Statin not presc disch	Statin not prescribed at discharge
G9448	Born 1945-1965	Patients who were born in the years 1945 to 1965
G9449	Hx bld transf b/f 1992	History of receiving blood transfusions prior to 1992
G9450	Hx injec drug use	History of injection drug use
G9451	1x scrn hcv infect	Patient received one-time screening for hcv infection
G9452	Doc med reas no hcv test	Documentation of medical reason(s) for not receiving hcv antibody test due to limited life expectancy
G9453	Pt reas no hcv infect	Documentation of patient reason(s) for not receiving one-time screening for hcv infection (e.g., patient declined, other patient reasons)
G9454	No scr hcv inf 12 mth rp	One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given
G9455	Abd imag w/us, ct or mri	Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or contrast mri for hcc
G9456	Doc med pt reas no hcc scrn	Documentation of medical or patient reason(s) for not ordering or performing screening for hcc. medical reason: comorbid medical conditions with expected survival < 5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons; patient reasons: patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment)
G9457	Pt no abd img no doc rsn	Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period
G9458	Tob user recd cess interv	Patient documented as tobacco user and received tobacco cessation intervention (must include at least one of the following: advice given to quit smoking or tobacco use, counseling on the benefits of quitting smoking or tobacco use, assistance with or referral to external smoking or tobacco cessation support programs, or current enrollment in smoking or tobacco use cessation program) if identified as a tobacco user
G9459	Tob non-user	Currently a tobacco non-user
G9460	No tob assess or cess inter	Tobacco assessment or tobacco cessation intervention not performed, reason not given
G9463	Sinusitis intent	I intend to report the sinusitis measures group
G9464	Sinusitis comp	All quality actions for the applicable measures in the sinusitis measures group have been performed for this patient
G9465	Aoe intent	I intend to report the acute otitis externa (aoe) measures group
G9466	Aoe comp	All quality actions for the applicable measures in the aoe measures group have been performed for this patient
G9467	Recd cortico >=10mg/day >60d	Patient who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills within the last twelve months
G9468	No recd cortico>=10mg/d >60d	Patient not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills
G9469	Rec cortico>90d or 1rx 900mg	Patients 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
G9470	No rec cortico>60d 1rx 600mg	Patients not receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600 mg prednisone or greater for all fills
G9471	W/in 2yr dxa not order	Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered or documented
G9472	No dxa no med hx no rv sx	Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not ordered and documented, no review of systems and no medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
G9473	Chap services at hospice	Services performed by chaplain in the hospice setting, each 15 minutes
G9474	Diet counsel at hospice	Services performed by dietary counselor in the hospice setting, each 15 minutes
G9475	Other counselor at hospice	Services performed by other counselor in the hospice setting, each 15 minutes
G9476	Volun service at hospice	Services performed by volunteer in the hospice setting, each 15 minutes
G9477	Care coord at hospice	Services performed by care coordinator in the hospice setting, each 15 minutes
G9478	Othe therapist at hospice	Services performed by other qualified therapist in the hospice setting, each 15 minutes
G9479	Pharmacist at hospice	Services performed by qualified pharmacist in the hospice setting, each 15 minutes
G9480	Admission to mccm	Admission to medicare care choice model program (mccm)
G9481	Remote e/m new pt 10mins	Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9482	Remote e/m new pt 20mins	Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9483	Remote e/m new pt 30mins	Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate severity. typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9484	Remote e/m new pt 45mins	Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9485	Remote e/m new pt 60mins	Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9486	Remote e/m est. pt 10mins	Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are self limited or minor. typically, 10 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9487	Remote e/m est. pt 15mins	Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of low to moderate severity. typically, 15 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9488	Remote e/m est. pt 25mins	Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9489	Remote e/m est. pt 40mins	Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved coms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9490	Cmmi mod home visit	Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code
G9496	Doc rsn no adeno/neopl detec	Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g., neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
G9497	Rec inst no smoke day surg	Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery
G9498	Abx reg prescribed	Antibiotic regimen prescribed
G9499	No start/rec antvir tx hep c	Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period
G9500	Rad expos ind/exp tm doc	Radiation exposure indices documented in final report for procedure using fluoroscopy
G9501	Rad expos ind/exp tm no doc	Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given
G9502	Med reas no perf foot exam	Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)
G9503	Pt tk tams hcl	Patient taking tamsulosin hydrochloride
G9504	Doc rsn hep b stat not asses	Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
G9505	Abx pres w/in 10 dys of symp	Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
G9506	Bio imm resp mod presc	Biologic immune response modifier prescribed
G9507	Doc reas on statin or contra	Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
G9508	Doc pt not on statin	Documentation that the patient is not on a statin medication
G9509	Adit mdd dys rem 12 mnths	Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
G9510	Remis12m not phq-9 score <5	Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5
G9511	Idx evt dte phq>9 doc 12 mo	Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
G9512	Indiv pdc > 0.8	Individual had a pdc of 0.8 or greater
G9513	Indiv pdc not > 0.8	Individual did not have a pdc of 0.8 or greater
G9514	Req ret or w/in 90d of surg	Patient required a return to the operating room within 90 days of surgery
G9515	No reas, no ret or w/in 90d	Patient did not require a return to the operating room within 90 days of surgery
G9516	Impr vis acuit w/in 90d	Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery
G9517	No impr vis acuit w/in 90d	Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given
G9518	Doc active inj drug use	Documentation of active injection drug use
G9519	Final ref +/- 1.0 w/in 90d	Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
G9520	Refract not +/- 1.0 w/in 90d	Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
G9521	Er and ip hosp <2 in 12 mos	Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
G9522	Er/ip hosp =/>2 in 12 mos	Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given
G9523	D/c hemo or perit dialysis	Patient discontinued from hemodialysis or peritoneal dialysis
G9524	Refer to hospice	Patient was referred to hospice care
G9525	Doc pt reas no hospice refer	Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)
G9526	No reason, no refer hospice	Patient was not referred to hospice care, reason not given
G9529	Minor blunt trauma w/head ct	Patient with minor blunt head trauma had an appropriate indication(s) for a head ct
G9530	Pt mbht hd ct ord ec prov	Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
G9531	Pt doc	Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar
G9532	Pt hd ct ord	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
G9533	Indic for head ct not valid	Patient with minor blunt head trauma did not have an appropriate indication(s) for a head ct
G9534	Adv brain image not ordered	Advanced brain imaging (cta, ct, mra or mri) was not ordered
G9535	Normal neuro exam	Patients with a normal neurological examination
G9536	Doc med reas adv brain image	Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms)
G9537	Img hd clin trial	Imaging needed as part of a clinical trial; or other clinician ordered the study
G9538	Adv brain image ordered	Advanced brain imaging (cta, ct, mra or mri) was ordered
G9539	Intent pot remv time placemt	Intent for potential removal at time of placement
G9540	Pt alive 3 mos post proc	Patient alive 3 months post procedure
G9541	Filter rem 3 mon plmt	Filter removed within 3 months of placement
G9542	Doc reass appr remo filt 3ms	Documented re-assessment for the appropriateness of filter removal within 3 months of placement
G9543	Doc 2x re-assess filt remov	Documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement
G9544	No filt remov w/in 3mos plcm	Patients that do not have the filter removed, documented re-assessment for the appropriateness of filter removal, or documentation of at least two attempts to reach the patient to arrange a clinical re-assessment for the appropriateness of filter removal within 3 months of placement
G9547	Cys ren les or adren	Cystic renal lesion that is simple appearing (bosniak i or ii) , or adrenal lesion less than or equal to 1.0 cm or adrenal lesion greater than 1.0 cm but less than or equal to 4.0 cm classified as likely benign by unenhanced ct or washout protocol ct, or mri with in- and opposed-phase sequences or other equivalent institutional imaging protocols
G9548	No f/u rec image study	Final reports for imaging studies stating no follow-up imaging is recommended
G9549	Doc med rsn for f/u imag	Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has lymphadenopathy, signs of metastasis or an active diagnosis or history of cancer, and other medical reason(s))
G9550	Imag rec	Final reports for imaging studies with follow-up imaging recommended, or final reports that do not include a specific recommendation of no follow-up
G9551	Imag no les	Final reports for imaging studies without an incidentally found lesion noted
G9552	Inc thyr node <1.0 in rpt	Incidental thyroid nodule < 1.0 cm noted in report
G9553	Prior thyroid dise dx	Prior thyroid disease diagnosis
G9554	Ct/cta/mri/a chst foll rec	Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging recommended
G9555	Doc med rsn for follup image	Documentation of medical reason(s) for recommending follow up imaging (e.g., patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy, other medical reason(s))
G9556	Ct/cta/mri/a no follup imag	Final reports for ct, cta, mri or mra of the chest or neck with follow-up imaging not recommended
G9557	Ct/cta/mri/a no thyr <1.0cm	Final reports for ct, cta, mri or mra studies of the chest or neck without an incidentally found thyroid nodule < 1.0 cm noted or no nodule found
G9558	Tx beta-lactam abx therapy	Patient treated with a beta-lactam antibiotic as definitive therapy
G9559	Doc med reas no abx therapy	Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic (e.g., allergy, intolerance to beta-lactam antibiotics)
G9560	No beta-lactam abx ther, rng	Patient not treated with a beta-lactam antibiotic as definitive therapy, reason not given
G9561	Presc opiates >6 wks	Patients prescribed opiates for longer than six weeks
G9562	Foll-up eval q3mo opiod tx	Patients who had a follow-up evaluation conducted at least every three months during opioid therapy
G9563	No f/u eval q3mo opiod tx	Patients who did not have a follow-up evaluation conducted at least every three months during opioid therapy
G9572	Phq-scr >9 doc in 12m time	Index date phq-score greater than 9 documented during the twelve month denominator identification period
G9573	Adl pt md or dys rem 6 mon	Adult 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
G9574	Adl pt md dys no rem 6 mon	Adult 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
G9577	Presc opiates >6 wks	Patients prescribed opiates for longer than six weeks
G9578	Doc opioid tx 1x during ther	Documentation of signed opioid treatment agreement at least once during opioid therapy
G9579	No doc opioid tx 1x at ther	No documentation of signed an opioid treatment agreement at least once during opioid therapy
G9580	Door to punc time <2hrs	Door to puncture time of 90 minutes or less
G9581	Md doc, door to punc tm >2hr	Door to puncture time of greater than 2 hours for reasons documented by clinician (e.g., patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment; hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment)
G9582	Door to punc time >2hr, nrg	Door to puncture time of greater than 90 minutes, no reason given
G9583	Presc opiates >6 wks	Patients prescribed opiates for longer than six weeks
G9584	Eval opioid use instr/pt int	Patient evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least once during opioid therapy
G9585	No eval opi use instr/intv	Patient not evaluated for risk of misuse of opiates by using a brief validated instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at least once during opioid therapy
G9593	Low pecarn ped head trauma	Pediatric patient with minor blunt head trauma classified as low risk according to the pecarn prediction rules
G9594	Pt mbht hd ct ord ec prov	Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
G9595	Doc shnt/tum/coag	Patient has documentation of ventricular shunt, brain tumor, or coagulopathy
G9596	Ped pt hd ct ord	Pediatric 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
G9597	No low pecarn ped head traum	Pediatric patient with minor blunt head trauma not classified as low risk according to the pecarn prediction rules
G9598	Aor ane 5.5-5.9 cm max diam	Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
G9599	Aor ane >=6.0 cm max diam	Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct or minor diameter on axial formatted ct
G9600	Symp aaa urgent repair	Symptomatic aaas that required urgent/emergent (non-elective) repair
G9601	Pt dchg home post op day 7	Patient discharge to home no later than post-operative day #7
G9602	Pt no dchg home postop day 7	Patient not discharged to home by post-operative day #7
G9603	Pt surv improv bsline tx	Patient survey score improved from baseline following treatment
G9604	Pt surv results not avail	Patient survey results not available
G9605	Surv score no improv w/tx	Patient survey score did not improve from baseline following treatment
G9606	Intraop cyst eval trac inj	Intraoperative cystoscopy performed to evaluate for lower tract injury
G9607	Doc med rsn not perf cystosc	Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death
G9608	Intraop cyst eval not done	Intraoperative cystoscopy not performed to evaluate for lower tract injury
G9609	Doc order anti-plat	Documentation of an order for anti-platelet agents
G9610	Doc md rsn no antipla	Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents
G9611	No doc order anti-plat rng	Order for anti-platelet agents was not documented in the patient's record, reason not given
G9612	Phodoc 2 mr cec lndmk	Photodocumentation of two or more cecal landmarks to establish a complete examination
G9613	Doc post surg anatomy	Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.)
G9614	Photodoc < 2 cec lndmk	Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination
G9615	Pre-op asst doc	Preoperative assessment documented
G9616	Doc rsn no preop assmt	Documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery)
G9617	Pre-op asst not doc, rng	Preoperative assessment not documented, reason not given
G9618	Doc scr uter mal or us/samp	Documentation of screening for uterine malignancy or those that had an ultrasound and/or endometrial sampling of any kind
G9619	Doc rsn no scr uter malig	Documentation of reason(s) for not screening for uterine malignancy (e.g., prior hysterectomy)
G9620	No scr utr malig/us/samp rng	Patient not screened for uterine malignancy, or those that have not had an ultrasound and/or endometrial sampling of any kind, reason not given
G9621	Scr unheal etoh w/counsel	Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling
G9622	No unheal etoh user	Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
G9623	Doc med rsn no scr etoh use	Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
G9624	Pt not scrn or no counseling	Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user
G9625	Pt bl srg 30 day pst srg	Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery
G9626	Med rsn no rpt bladder inj	Documented medical reason for not reporting bladder injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury)
G9627	Pt no bl srg 30 day pst srg	Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
G9628	Pt bwli srg 30 day pst srg	Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery
G9629	Med rsn no rpt bowel inj	Documented medical reasons for not reporting bowel injury (e.g., gynecologic or other pelvic malignancy documented, planned (e.g., not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury)
G9630	Pt no bwli srg 30 day srg	Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
G9631	Pt ui srg 30 day pst srg	Patient sustained ureter injury at the time of surgery or discovered subsequently up to 30 days post-surgery
G9632	Med rsn for no rpt uret inj	Documented medical reasons for not reporting ureter injury (e.g., gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of ureter injury)
G9633	Pt no ui srg 30 day pst srg	Patient did not sustain ureter injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
G9634	Qual life tool 2x same/impr	Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved
G9635	No doc rsn do qual life assm	Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the hrqol survey, patient has the inability to read and/or write in order to complete the hrqol questionnaire)
G9636	No life asst 2x same/decr	Health-related quality of life not assessed with tool during at least two visits or quality of life score declined
G9637	Doc >1 dose reduc tech	Final reports with documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)
G9638	No doc >1 dose reduc tech	Final reports without documentation of one or more dose reduction techniques (e.g., automated exposure control, adjustment of the ma and/or kv according to patient size, use of iterative reconstruction technique)
G9639	Amp no reqd in48h ieler proc	Major amputation or open surgical bypass not required within 48 hours of the index endovascular lower extremity revascularization procedure
G9640	Doc plan hybrid/stage proc	Documentation of planned hybrid or staged procedure
G9641	Amp reqd w/in 48h ieler proc	Major amputation or open surgical bypass required within 48 hours of the index endovascular lower extremity revascularization procedure
G9642	Current smoker	Current smoker (e.g., cigarette, cigar, pipe, e-cigarette or marijuana)
G9643	Elective surgery	Elective surgery
G9644	No smok b/4 anes day of surg	Patients who abstained from smoking prior to anesthesia on the day of surgery or procedure
G9645	Had smoke b/4 anes day surg	Patients who did not abstain from smoking prior to anesthesia on the day of surgery or procedure
G9646	Pt w/90d mrs 0-2	Patients with 90 day mrs score of 0 to 2
G9647	No mrs score in 90d followup	Patients in whom mrs score could not be obtained at 90 day follow-up
G9648	Pt w/90d mrs >2	Patients with 90 day mrs score greater than 2
G9649	Psor as doc spc bm	Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi))
G9650	Doc pt no ther chg or contra	Documentation that the patient declined therapy change or has documented contraindications (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
G9651	Psor as doc no spc bm	Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa), psoriasis area and severity index (pasi) and/or dermatology life quality index) (dlqi)) or psoriasis assessment tool not documented
G9652	Pt tx sys bio med psori 6mth	Patient has been treated with a systemic or biologic medication for psoriasis for at least six months
G9653	Pt no tx sys bio rx 6 mths	Patient has not been treated with a systemic or biologic medication for psoriasis for at least six months
G9654	Mon anesth care	Monitored anesthesia care (mac)
G9655	Toc tool incl key elem	A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is used
G9656	Pt trans from anest to pacu	Patient transferred directly from anesthetizing location to pacu or other non-icu location
G9657	Toc dur aneth to icu	Transfer of care during an anesthetic or to the intensive care unit
G9658	Toc tool incl elem not used	A transfer of care protocol or handoff tool/checklist that includes the required key handoff elements is not used
G9659	>=86y no hx colo ca/rsn scop	Patients 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, crohn's disease (i.e., regional enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits
G9660	Doc med rsn scope pt >= 86y	Documentation 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, crohn's disease (i.e., regional enteritis), familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits)
G9661	Pt >= 86 w/ hi risk	Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions
G9662	Prior dx/active clin ascvd	Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure
G9663	Fast/dir ldl >= 190 mg/dl	Any ldl-c laboratory result >= 190 mg/dl
G9664	Taking statin or rec'd order	Patients who are currently statin therapy users or received an order (prescription) for statin therapy
G9665	No statin/no order statin	Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy
G9666	Fas/dir ldl 70-189mg/dl mst	Patient'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
G9667	Doc med rsn no stat tx/presc	Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy)
G9669	Intend rpt mult chr msr grp	I intend to report the multiple chronic conditions measures group
G9670	Qty act mcc mg perf	All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient
G9671	Intend rpt dia retin msr grp	I intend to report the diabetic retinopathy measures group
G9672	Qty act diab retin mg perf	All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient
G9673	Intend rpt card prev msr grp	I intend to report the cardiovascular prevention measures group
G9674	Pt w/clin ascvd dx	Patients with clinical ascvd diagnosis
G9675	Pt w/fast/dir lab ldl-c >190	Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl
G9676	40-75y w/type 1/2 w/ldl-c rs	Patients aged 40 to 75 years at the beginning of the measurement period with type 1 or type 2 diabetes and with an ldl-c result of 70-189 mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period
G9677	Qty act card prev mg perf	All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patient
G9678	Oncology care model service	Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation agreement
G9679	Acute care pneumonia	This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary
G9680	Acute care congestive heart	This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary
G9681	Acute care chronic obstruct	This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary
G9682	Acute care skin infection	This code is for the onsite acute care treatment a nursing facility resident with a skin infection; may only be billed once per day per beneficiary
G9683	Acute fluid/electro disorder	Facility service(s) for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder. (may only be billed once per day per beneficiary). this service is for a demonstration project
G9684	Acute care urinary tract inf	This code is for the onsite acute care treatment of a nursing facility resident for a uti; may only be billed once per day per beneficiary
G9685	Acute nursing facility care	Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project
G9686	Nursing facility conference	Onsite nursing facility conference, that is separate and distinct from an evaluation and management visit, including qualified practitioner and at least one member of the nursing facility interdisciplinary care team
G9687	Hospice anytime msmt per	Hospice services provided to patient any time during the measurement period
G9688	Pt w/hosp anytime msmt per	Patients using hospice services any time during the measurement period
G9689	Inpt elect carotid intervent	Patient admitted for performance of elective carotid intervention
G9690	Pt in hos	Patient receiving hospice services any time during the measurement period
G9691	Pt hosp dur msmt period	Patient had hospice services any time during the measurement period
G9692	Hosp recd by pt dur msmt per	Hospice services received by patient any time during the measurement period
G9693	Pt use hosp during msmt per	Patient use of hospice services any time during the measurement period
G9694	Hosp srv used pt in msmt per	Hospice services utilized by patient any time during the measurement period
G9695	Long act inhal bronchdil pre	Long-acting inhaled bronchodilator prescribed
G9696	Med rsn no presc bronchdil	Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., patient intolerance or history of side effects)
G9697	Pt rsn no presc bronchdil	Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator
G9698	Sys rsn no presc bronchdil	Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (e.g., cost of treatment or lack of insurance)
G9699	Long inhal bronchdil no pres	Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified
G9700	Pt is w/hosp during msmt per	Patients who use hospice services any time during the measurement period
G9701	Child anbx 30 prior dx estab	Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established
G9702	Pt use hosp during msmt per	Patients who use hospice services any time during the measurement period
G9703	Anbx 30 prior to episode	Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
G9704	Ajcc br ca stg i: t1 mic/t1a	Ajcc breast cancer stage i: t1 mic or t1a documented
G9705	Ajcc br ca stg ib	Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented
G9706	Low recur prost ca	Low (or very low) risk of recurrence, prostate cancer
G9707	Pt had hosp dur msmt per	Patient received hospice services any time during the measurement period
G9708	Bilat mast/hx bi /unilat mas	Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy
G9709	Hosp srv used pt in msmt per	Hospice services used by patient any time during the measurement period
G9710	Pt prov hosp srv msmt per	Patient was provided hospice services any time during the measurement period
G9711	Pt hx tot col or colon ca	Patients with a diagnosis or past history of total colectomy or colorectal cancer
G9712	Doc med rsn presc anbx	Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis
G9713	Pt use hosp during msmt per	Patients who use hospice services any time during the measurement period
G9714	Pt is w/hosp during msmt per	Patient is using hospice services any time during the measurement period
G9715	Pt w/hosp anytime msmt per	Patients who use hospice services any time during the measurement period
G9716	Bmi doc onl fup not cmpltd	Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
G9717	Doc pt dx bipol	Documentation stating the patient has had a diagnosis of bipolar disorder
G9718	Hospice anytime msmt per	Hospice services for patient provided any time during the measurement period
G9719	Pt not ambul/immob/wc	Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
G9720	Hospice anytime msmt per	Hospice services for patient occurred any time during the measurement period
G9721	Pt not ambul/immob/wc	Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
G9722	Doc hx renal fail or cr+ >=4	Documented history of renal failure or baseline serum creatinine >= 4.0 mg/dl; renal transplant recipients are not considered to have preoperative renal failure, unless, since transplantation the cr has been or is 4.0 or higher
G9723	Hosp recd by pt dur msmt per	Hospice services for patient received any time during the measurement period
G9724	Pt w/doc use anticoag mst yr	Patients who had documentation of use of anticoagulant medications overlapping the measurement year
G9725	Pt w/hosp anytime msmt per	Patients who use hospice services any time during the measurement period
G9726	Refused to participate	Patient refused to participate
G9727	Pt unable cmplt lepf prom	Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
G9728	Refused to participate	Patient refused to participate
G9729	Pt unbl cmplt lepf prom	Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
G9730	Refused to participate	Patient refused to participate
G9731	Pt unbl cmplt lepf prom	Patient unable to complete the lepf prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
G9732	Refused to participate	Patient refused to participate
G9733	Pt unbl cmplt lb fs prom	Patient unable to complete the low back fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
G9734	Refused to participate	Patient refused to participate
G9735	Pt unbl cmplt shld fs prom	Patient unable to complete the shoulder fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
G9736	Refused to participate	Patient refused to participate
G9737	Pt unbl cmplt ewh fs prom	Patient unable to complete the elbow/wrist/hand fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available
G9738	Refused to participate	Patient refused to participate
G9739	Pt unbl cmplt go fs prom	Patient 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
G9740	Hosp srv to pt dur msmt per	Hospice services given to patient any time during the measurement period
G9741	Pt w/hosp anytime msmt per	Patients who use hospice services any time during the measurement period
G9742	Psych sympt assessed	Psychiatric symptoms assessed
G9743	Psych symp not assessed, rns	Psychiatric symptoms not assessed, reason not otherwise specified
G9744	Pt not eli d/t act dig htn	Patient not eligible due to active diagnosis of hypertension
G9745	Doc rsn no hbp scrn or f/u	Documented reason for not screening or recommending a follow-up for high blood pressure
G9746	Mit sten, valve or trans af	Patient has mitral stenosis or prosthetic heart valves or patient has transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
G9747	Pall dialysis with catheter	Patient is undergoing palliative dialysis with a catheter
G9748	App transpl lvg kidney donor	Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
G9749	Pall dialysis with catheter	Patient is undergoing palliative dialysis with a catheter
G9750	App transpl lvg kidney donor	Patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant
G9751	Pt died w/in 24 mos rpt time	Patient died at any time during the 24-month measurement period
G9752	Urgent surgery	Emergency surgery
G9753	Doc no dicom, ct other fac	Documentation of medical reason for not conducting a search for dicom format images for prior patient ct imaging studies completed at non-affiliated external healthcare facilities or entities within the past 12 months that are available through a secure, authorized, media-free, shared archive (e.g., trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of the essence)
G9754	Incid pulm nodule	A finding of an incidental pulmonary nodule
G9755	Doc med rsn no fllw up	Documentation of medical reason(s) for not including a recommended interval and modality for follow-up or for no follow-up, and source of recommendations (e.g., patients with unexplained fever, immunocompromised patients who are at risk for infection)
G9756	Surg proc w/silicone oil	Surgical procedures that included the use of silicone oil
G9757	Surg proc w/silicone oil	Surgical procedures that included the use of silicone oil
G9758	Pt in hos	Patient in hospice at any time during the measurement period
G9759	Hx preop post cap rup	History of preoperative posterior capsule rupture
G9760	Pt w/hosp anytime msmt per	Patients who use hospice services any time during the measurement period
G9761	Pt w/hosp anytime msmt per	Patients who use hospice services any time during the measurement period
G9762	Pt had >= 2-3 hpv vaccines	Patient had at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
G9763	Pt not have 2-3 hpv vaccines	Patient did not have at least two hpv vaccines (with at least 146 days between the two) or three hpv vaccines on or between the patient's 9th and 13th birthdays
G9764	Pt treatd w/oral syst or bio	Patient has been treated with a systemic medication for psoriasis vulgaris
G9765	Doc pat declined therapy	Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
G9766	Cva stroke dx tx transf fac	Patients who are transferred from one institution to another with a known diagnosis of cva for endovascular stroke treatment
G9767	Hosp new dx cva consid evst	Hospitalized patients with newly diagnosed cva considered for endovascular stroke treatment
G9768	Pt w/hosp anytime msmt per	Patients who utilize hospice services any time during the measurement period
G9769	Bn den 2yr/got ost med/ther	Patient had a bone mineral density test in the past two years or received osteoporosis medication or therapy in the past 12 months
G9770	Perip nerve block	Peripheral nerve block (pnb)
G9771	Anes end, 1 temp >35.5(95.9)	At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time
G9772	Doc med rsn no temp >= 35.5	Documentation of medical reason(s) for not achieving at least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time (e.g., emergency cases, intentional hypothermia, etc.)
G9773	1 bod temp >=35.5	At least 1 body temperature measurement equal to or greater than 35.5 degrees celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes immediately before or 15 minutes immediately after anesthesia end time, reason not given
G9774	Pt had hyst	Patients who have had a hysterectomy
G9775	Recd 2 anti-emet pre/intraop	Patient received at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
G9776	Doc med rsn no proph antiem	Documentation of medical reason for not receiving at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively (e.g., intolerance or other medical reason)
G9777	Pt no antiemet pre/intraop	Patient did not receive at least 2 prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
G9778	Pts dx w/pregn	Patients who have a diagnosis of pregnancy at any time during the measurement period
G9779	Pts breastfeeding	Patients who are breastfeeding at any time during the performance period
G9780	Pts dx w/rhabdomyolysis	Patients who have a diagnosis of rhabdomyolysis at any time during the performance period
G9781	Doc rsn no statin	Documentation of medical reason(s) for not currently being a statin therapy user or receiving an order (prescription) for statin therapy (e.g., patients with statin-associated muscle symptoms or an allergy to statin medication therapy, patients who are receiving palliative or hospice care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease [esrd], or other medical reasons)
G9782	Hx dx fam/pure hypercholes	History of or active diagnosis of familial hypercholesterolemia
G9783	Doc dx dm, fast <70, no stat	Documentation of patients with diabetes who have a most recent fasting or direct ldl- c laboratory test result < 70 mg/dl and are not taking statin therapy
G9784	Path/derm prov 2nd biop opin	Pathologists/dermatopathologists providing a second opinion on a biopsy
G9785	Path report sent	Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
G9786	Path report not sent	Pathology report diagnosing cutaneous basal cell carcinoma, squamous cell carcinoma, or melanoma (to include in situ disease) was not sent from the pathologist/ dermatopathologist to the biopsying clinician for review within 7 days from the time when the tissue specimen was received by the pathologist
G9787	Pt alive	Patient alive as of the last day of the measurement year
G9788	Most rct bp	Most recent bp is less than or equal to 140/90 mm hg
G9789	Record bp ip, er, urg/self	Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits
G9790	Most rct bp >/= 140/90	Most recent bp is greater than 140/90 mm hg, or blood pressure not documented
G9791	Most rct tob stat free	Most recent tobacco status is tobacco free
G9792	Most rct tob stat not free	Most recent tobacco status is not tobacco free
G9793	Pt on daily asa/antiplat	Patient is currently on a daily aspirin or other antiplatelet
G9794	Doc med rsn no daily aspirin	Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)
G9795	Pt no daily asa/antiplat	Patient is not currently on a daily aspirin or other antiplatelet
G9796	Pt not currently on statin	Patient is currently on a statin therapy
G9797	Pt currently on statin	Patient is not on a statin therapy
G9798	D/c ami btw 7/1-6/30 meas pd	Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement period
G9799	Med disp evt indic hx asth	Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure period
G9800	Pt id intol/alleg beta-block	Patients who are identified as having an intolerance or allergy to beta-blocker therapy
G9801	Nonacut transf from inpt	Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis
G9802	Pt w/hosp anytime msmt per	Patients who use hospice services any time during the measurement period
G9803	Pt presc 135 day trmt	Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
G9804	Pt not presc 135 day trmt	Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
G9805	Pt w/hosp anytime msmt per	Patients who use hospice services any time during the measurement period
G9806	Pt recd cerv cyto/hpv	Patients who received cervical cytology or an hpv test
G9807	Pt no recd cerv cyto/hpv	Patients who did not receive cervical cytology or an hpv test
G9808	Pt no asthm cont med mst per	Any patients who had no asthma controller medications dispensed during the measurement year
G9809	Pt w/hosp anytime msmt per	Patients who use hospice services any time during the measurement period
G9810	Pdc 75% w/asth cont med	Patient achieved a pdc of at least 75% for their asthma controller medication
G9811	No pdc 75% w/asth cont med	Patient did not achieve a pdc of at least 75% for their asthma controller medication
G9812	Pt died during inpt/30d aft	Patient died including all deaths occurring during the hospitalization in which the operation was performed, even if after 30 days, and those deaths occurring after discharge from the hospital, but within 30 days of the procedure
G9813	Pt not died w/in 30d of proc	Patient did not die within 30 days of the procedure or during the index hospitalization
G9814	Death during index hosp	Death occurring during the index acute care hospitalization
G9815	Death not during index hosp	Death did not occur during the index acute care hospitalization
G9816	Death <30 day post discharge	Death occurring after discharge from the hospital but within 30 days post procedure
G9817	No death 30-days post-disch	Death did not occur after discharge from the hospital within 30 days post procedure
G9818	Doc sex activity	Documentation of sexual activity
G9819	Pt w/hosp anytime msmt per	Patients who use hospice services any time during the measurement period
G9820	Doc chlam scr test w/follow	Documentation of a chlamydia screening test with proper follow-up
G9821	No doc chlam scr ts w/follow	No documentation of a chlamydia screening test with proper follow-up
G9822	Endo abl proc yr prev ind dt	Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date)
G9823	Endo smpl/hyst bx res doc	Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
G9824	Endo smpl/hyst bx res no doc	Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation
G9825	Her-2 neg,undoc/unkn	Her-2/neu negative or undocumented/unknown
G9826	Transf pract aft init chemo	Patient transferred to practice after initiation of chemotherapy
G9827	Her-2 targ ther no init tx	Her2-targeted therapies not administered during the initial course of treatment
G9828	Her-2 targ ther dur init tx	Her2-targeted therapies administered during the initial course of treatment
G9829	Breast adj chemo admin	Breast adjuvant chemotherapy administered
G9830	Her-2 pos	Her-2/neu positive
G9831	Ajcc stg brt ca dx ii or iii	Ajcc stage at breast cancer diagnosis = ii or iii
G9832	Brt ca dx i, no t1/t1a/t1b	Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis does not equal = t1, t1a, t1b
G9833	Transf pract aft init chemo	Patient transfer to practice after initiation of chemotherapy
G9834	Pt met dis at dx	Patient has metastatic disease at diagnosis
G9835	Trastuz given w/in 12 mos dx	Trastuzumab administered within 12 months of diagnosis
G9836	Rsn no trast given doc	Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)
G9837	Trastuz not in 12 mos dx	Trastuzumab not administered within 12 months of diagnosis
G9838	Pt met dis at dx	Patient has metastatic disease at diagnosis
G9839	Anti-egfr mon anti ther	Anti-egfr monoclonal antibody therapy
G9840	Gene testing performed	Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab
G9841	Gene testing not performed	Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab
G9842	Pt met dis at dx	Patient has metastatic disease at diagnosis
G9843	Kras or nras gene mutation	Ras (kras or nras) gene mutation
G9844	Pt no recd anti-egfr ther	Patient did not receive anti-egfr monoclonal antibody therapy
G9845	Pt recd anti-egfr ther	Patient received anti-egfr monoclonal antibody therapy
G9846	Pt died from cancer	Patients who died from cancer
G9847	Pt recd chemo last 14d life	Patient received systemic cancer-directed therapy in the last 14 days of life
G9848	Pt no chemo last 14d life	Patient did not receive systemic cancer-directed therapy in the last 14 days of life
G9849	Pt died from cancer	Patients who died from cancer
G9850	1/more ed last 30d life	Patient had more than one emergency department visit in the last 30 days of life
G9851	1/no ed visit last 30d life	Patient had one or less emergency department visits in the last 30 days of life
G9852	Pt died from cancer	Patients who died from cancer
G9853	Icu stay last 30d life	Patient admitted to the icu in the last 30 days of life
G9854	No icu stay last 30d life	Patient was not admitted to the icu in the last 30 days of life
G9855	Pt died from cancer	Patients who died from cancer
G9856	Pt no hospice	Patient was not admitted to hospice
G9857	Pt admit hospice	Patient admitted to hospice
G9858	Pt enroll hospice	Patient enrolled in hospice
G9859	Pt died from cancer	Patients who died from cancer
G9860	Pt less 3d hospice	Patient spent less than three days in hospice care
G9861	Pt more than 3d hospice	Patient spent greater than or equal to three days in hospice care
G9862	Doc rsn no 10 yr follow	Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons)
G9868	Cmmi asyntelehealth <10min	Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, less than 10 minutes
G9869	Cmmi asyntelehealth 10-20min	Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, 10-20 minutes
G9870	Cmmi asyntelehealth >20min	Receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, for use only in a medicare-approved cmmi model, more than 20 minutes
G9873	1 em core session	First medicare diabetes prevention program (mdpp) core session was attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
G9874	4 em core sessions	Four total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
G9875	9 em core sessions	Nine total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em). a core session is an mdpp service that: (1) is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions
G9876	2 em core ms mo 7-9 no wl	Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9
G9877	2 em core ms mo 10-12 no wl	Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12
G9878	2 em core ms mo 7-9 wl	Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions.the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9
G9879	2 em core ms mo 10-12 wl	Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary achieved at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12
G9880	Em 5 percent wl	The 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
G9881	Em 9 percent wl	The 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
G9882	2 em ongoing ms mo 13-15 wl	Two 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
G9883	2 em ongoing ms mo 16-18 wl	Two 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
G9884	2 em ongoing ms mo 19-21 wl	Two 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
G9885	2 em ongoing ms mo 22-24 wl	Two 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
G9886	In-person attendance g code	Behavioral counseling for diabetes prevention, in-person, group, 60 minutes
G9887	Distance learning attendance	Behavioral counseling for diabetes prevention, distance learning, 60 minutes
G9888	5% wl maintnd from bsline wt	Maintenance 5% wl from baseline weight in months 7-12
G9890	Em bridge payment	Bridge 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
G9891	Em session reporting	Mdpp 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)
G9892	Doc pt rsn no dil mac exam	Documentation of patient reason(s) for not performing a dilated macular examination
G9893	No mac exam	Dilated macular exam was not performed, reason not otherwise specified
G9894	Adr dep thrpy prescribed	Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate
G9895	Doc med rsn no adr dep thrpy	Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy)
G9896	Doc pt rsn no adr dep thrpy	Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate
G9897	Pt nt prsc adr dep thrpy rng	Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given
G9898	Pt 66+ snp or ltc pos > 90d	Patients 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
G9899	Scrn mam perf rslts doc	Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
G9900	Scrn mam perf rslts not doc	Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
G9901	Pt 66+ snp or ltc pos > 90d	Patient 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
G9902	Pt scrn tbco and id as user	Patient screened for tobacco use and identified as a tobacco user
G9903	Pt scrn tbco id as non user	Patient screened for tobacco use and identified as a tobacco non-user
G9904	Doc med rsn no tbco scrn	Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)
G9905	No pt tbco scrn rng	Patient not screened for tobacco use
G9906	Pt recv tbco cess interv	Patient 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)
G9907	Doc med rsn no tbco interv	Documentation 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)
G9908	No pt tbco cess interv rng	Patient 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)
G9909	Doc med rsn no tbco interv	Documentation 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)
G9910	Pt 66+ snp or ltc pos > 90d	Patients 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
G9911	Node neg pre/post syst ther	Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy
G9912	Hbv status assesed and int	Hepatitis b virus (hbv) status assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy
G9913	No hbv status assesd and int	Hepatitis b virus (hbv) status not assessed and results interpreted prior to initiating anti-tnf (tumor necrosis factor) therapy, reason not otherwise specified
G9914	Pt initiated anti-tnf agent	Patient initiated an anti-tnf agent
G9915	No documntd hbv results rcd	No record of hbv results documented
G9916	Funct status past 12 months	Functional status performed once in the last 12 months
G9917	Adv dem crgvr limited	Documentation of advanced stage dementia and caregiver knowledge is limited
G9918	No funct stat perf, rsn nos	Functional status not performed, reason not otherwise specified
G9919	Scrn nd pos nd prov of rec	Screening performed and positive and provision of recommendations
G9920	Scrning perf and negative	Screening performed and negative
G9921	No or part scrn nd rng or os	No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified
G9922	Sfty cncrns scrn nd mit recs	Safety concerns screen provided and if positive then documented mitigation recommendations
G9923	Safty cncrns scrn and neg	Safety concerns screen provided and negative
G9924	Doc med rsn no scrn or recs	Documentation 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)
G9925	No scrn prov rsn nos	Safety concerns screening not provided, reason not otherwise specified
G9926	Sfty cncrns scrn but no recs	Safety concerns screening positive screen is without provision of mitigation recommendations, including but not limited to referral to other resources
G9927	Doc no warf /fda pt trial	Documentation 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
G9928	No warf or fda drug presc	Fda-approved anticoagulant not prescribed, reason not given
G9929	Trs/rev af	Patient with transient or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery)
G9930	Com care	Patients who are receiving comfort care only
G9931	No chad or chad scr 0 or 1	Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women
G9932	Doc pt rsn no tb scrn recrds	Documentation 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)
G9933	Canc detectd during col scrn	Adenoma(s) or colorectal cancer detected during screening colonoscopy
G9934	Doc rsn not detecting cancer	Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
G9935	Canc not detectd during srcn	Adenoma(s) or colorectal cancer not detected during screening colonoscopy
G9936	Pmh plyp/neo co/rect/jun/ans	Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus
G9937	Dig or surv colsco	Diagnostic colonoscopy
G9938	Pt 66+ snp or ltc pos > 90d	Patients 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
G9939	Same path/derm perf biopsy	Pathologists/dermatopathologists is the same clinician who performed the biopsy
G9940	Doc reas no statin therapy	Documentation 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)
G9941	Pre and post vas wthn 3 mos	Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively
G9942	Adtl spine proc on same date	Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
G9943	Bk pn nt msr vas scl pre/pst	Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
G9944	Vas 3 mon pre and 1 yr post	Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
G9945	Pt w/cancer scoliosis	Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
G9946	Bk pain no vas	Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
G9947	Pre and post vas wthn 3 mos	Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperatively
G9948	Adtl spine proc on same date	Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
G9949	Leg pain no vas	Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
G9954	Pt >2 rsk fac post-op vomit	Patient exhibits 2 or more risk factors for post-operative vomiting
G9955	Inhlnt anesth only for induc	Cases in which an inhalational anesthetic is used only for induction
G9956	Combo thrpy of >= 2 prophly	Patient received combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
G9957	Doc med rsn no combo thrpy	Documentation 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)
G9958	No combo prohpyl thrp for pt	Patient did not receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively
G9959	Systemic antimicro not presc	Systemic antimicrobials not prescribed
G9960	Med rsn sys antimi nt rx	Documentation of medical reason(s) for prescribing systemic antimicrobials
G9961	Systemic antimicro presc	Systemic antimicrobials prescribed
G9962	Embolization doc separatly	Embolization endpoints are documented separately for each embolized vessel and ovarian artery angiography or embolization performed in the presence of variant uterine artery anatomy
G9963	Embolization not doc separat	Embolization 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
G9964	Pt recv >=1 well-chld visit	Patient received at least one well-child visit with a pcp during the performance period
G9965	No well-chld vist recv by pt	Patient did not receive at least one well-child visit with a pcp during the performance period
G9966	Scrn, inter, report child	Children who were screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
G9967	No scrn, inter, reprt child	Children who were not screened for risk of developmental, behavioral and social delays using a standardized tool with interpretation and report
G9968	Pt refrd 2 pvdr/spclst in pp	Patient was referred to another clinician or specialist during the measurement period
G9969	Pvdr rfrd pt rprt rcvd	Clinician who referred the patient to another clinician received a report from the clinician to whom the patient was referred
G9970	Pvdr rfrd pt no rprt rcvd	Clinician who referred the patient to another clinician did not receive a report from the clinician to whom the patient was referred
G9974	Mac exam perf	Dilated 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
G9975	Doc med rsn no dil mac exam	Documentation of medical reason(s) for not performing a dilated macular examination
G9978	Remote e/m new pt 10mins	Remote 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
G9979	Remote e/m new pt 20mins	Remote 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
G9980	Remote e/m new pt 30 mins	Remote 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
G9981	Remote e/m new pt 45mins	Remote 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
G9982	Remote e/m new pt 60mins	Remote 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
G9983	Remote e/m est. pt 10mins	Remote 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
G9984	Remote e/m est. pt 15mins	Remote 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
G9985	Remote e/m est. pt 25mins	Remote 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
G9986	Remote e/m est. pt 40mins	Remote 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
G9987	Bpci advanced in home visit	Bundled 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
G9988	Pall serv during meas	Palliative care services provided to patient any time during the measurement period
G9989	Med rsn no pneum vax	Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., adverse reaction to vaccine)
G9990	No pneum vax admin 19+	Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
G9991	Pneum vax admin 19+	Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
G9992	Pall serv during meas	Palliative care services used by patient any time during the measurement period
G9993	Pall serv during meas	Patient was provided palliative care services any time during the measurement period
G9994	Pall serv during meas	Patient is using palliative care services any time during the measurement period
G9995	Pall serv during meas	Patients who use palliative care services any time during the measurement period
G9996	Doc pt pal or hospice	Documentation stating the patient has received or is currently receiving palliative or hospice care
G9997	Doc pt preg dur msrmt pd	Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
G9998	Doc med rsn <3 colon	Documentation 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])
G9999	Doc sys rsn <3 colon	Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, previous colonoscopy report was incomplete)