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2016 Quick Reference Guide for 2016 Physician Quality Reporting System Measures, Procedure Codes and G-codes

Use this guide to select the appropriate G-codes for reporting data on PQRS measures.

By Government Relations staff

The Physician Quality Reporting System (PQRS) is Medicare’s reporting program that asks eligible professionals (EPS), including psychologists, to submit data on specified quality measures to the Centers for Medicare and Medicaid Services (CMS). Reporting in PQRS consists of selecting measures that match your Medicare fee-for-service patients and identifying the services you provide to those patients. Medicare asks that you indicate whether or not the action described by the measures was taken through the use of a code (known as a “G” code) specific to each measure.

PQRS requirements in 2016 are the same as in 2015. EPs must report on nine measures across three domains or report on 20 patients using a measures group. For EPs who have face-to-face encounters with patients one of the nine measures must be a cross-cutting measure. EPs reporting on a measures group must use a qualified registry as measures groups are not eligible for claims-based reporting. To successfully report the EP must perform the action described in the measure at least once. The EP’s reporting will not satisfy PQRS requirements if a measure has a zero performance rate.

This chart provides a quick summary of the PQRS measures (in orange), procedure codes and G-codes available for each measure, based upon action taken. Prior to using this chart, providers will need to determine which measure is applicable by examining their Medicare population and identifying those with a diagnosis covered by an eligible measure. For 2016 some measures have been changed to electronic health record or registry reporting only and several have been eliminated.

EPs should review all measures carefully as some G codes have been changed for 2016. 


Applicable Procedure Codes Action Taken G-Code (or F-code where applicable)

Measure #128: Preventive Care And Screening: Body Mass Index Screening And Follow-Up
90791, 90832,
90834, 90837,
90839, 96150,
96151, 96152		 BMI documented as normal, no follow-up plan required G8420: Documented BMI within normal parameters and documented
BMI documented above normal parameters, follow-up documented G8417: Documented BMI above normal parameters and a follow-up is documented
BMI documented below normal parameters, follow-up documented G8418: Documented BMI below normal parameters and a follow-up plan is documented
BMI not documented, patient not eligible/not appropriate G8422: Patient not eligible for BMI calculation
BMI documented, patient not eligible/not appropriate for follow-up plan G8938: BMI is documented, but patient not eligible for follow-up plan
BMI not documented, reason not given G8421: BMI not documented no reason given
BMI documented outside normal parameters, follow-up plan not documented, reason not given G8419: Documented BMI outside normal parameters, no follow-up plan documented

Measure #130: Documentation And Verification Of Current Medications In The Medical Record

90791, 90832,
90834, 90837,
90839, 96116,
96150, 96151,
96152

 Current medications documented G8427: Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications
Current medications not documented, patient not eligible G8430: Eligible professional attests the patient is not eligible
Current medications with name, dosage, frequency, route not documented, reason not given G8428: Current medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given

Measure #131: Pain Assessment Prior To Initiation Of Patient Therapy And Follow-Up
90791, 96116,
96118, 96150,
96151		 Pain assessment documented as positive, follow-up plan not documented G8730: Pain assessment documented as positive utilizing a standardized tool and a follow-up plan is documented
Pain assessment documented as negative, no follow-up plan required G8731: Pain assessment documented as negative, no follow-up plan required
Pain assessment not documented, patient not eligible G8442: Documentation that patient is not eligible for a pain assessment
Pain assessment documented, follow-up plan not documented, patient not eligible G8939: Pain assessment documented, follow-up plan, not documented patient not eligible/appropriate
Pain assessment not documented, reason not given G8732: No documentation of pain assessment, reason not given
Pain assessment documented as positive, follow-up plan not documented, reason not given G8509: Documentation of positive pain assessment; no documentation of a follow-up plan, reason not given

Measure #134: Screening For Clinical Depression And Follow-Up Plan
90791, 90832,
90834, 90837,
90839, 96116,
96118, 96150,
96151		 Positive screen for clinical depression documented, follow-up plan documented G8431: Positive screen for clinical depression with a documented follow-up plan
Negative screen for clinical depression documented, follow-up plan not required G8510: Negative screen for clinical depression, follow-up not required
Screening for clinical depression not documented, patient not eligible G8433: Screening for clinical depression not documented, patient not eligible
Screening for clinical depression documented, follow-up plan not documented, patient not eligible/appropriate G8940: Screening for clinical depression documented, follow-up plan not documented, patient not eligible
Screening for clinical depression not documented, reason not given G8432: Clinical depression screening not documented, reason not given
Screening for clinical depression documented as positive, follow-up plan not documented, reason not given G8511: Screening for clinical depression documented as positive, follow-up plan not documented, reason not given

Measure #173: Preventive Care And Screening: Unhealthy Alcohol Use — Screening Has Been Eliminated And Replaced By Measure #431

Measure #181: Elder Maltreatment Screen And Follow-Up Plan
90791, 90832,
90834, 90837,
96116, 96150,
96151, 96152		 Elder maltreatment screen documented as positive and follow-up plan documented G8733: Documentation of a positive elder maltreatment screen and documented follow-up plan at the time of the positive screen
Elder maltreatment screen documented as negative, follow-up plan not required G8734: Elder maltreatment screen documented as negative, no follow-up required
Elder maltreatment screen not documented, patient not eligible G8535: No documentation of an elder maltreatment screen, patient not eligible
Elder maltreatment screen documented, patient not eligible for follow-up G8941: Elder maltreatment screen documented, patient not eligible for follow-up
Elder maltreatment screen not documented, reason not given G8536: No documentation of an elder maltreatment screen, reason not given
Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given G8735: elder maltreatment screen, documented as positive follow-up plan not documented, reason not given

Measure #226: Preventive Care And Screening: Tobacco Use: Screening And Cessation Intervention
90791, 90832,
90834, 90837,
90845, 96150,
96151, 96152		 Patient screened for tobacco use CPT II 4004F: Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user
Patient screened for tobacco use and identified as a non-user of tobacco CPT II 1036F: Current tobacco non-user
Tobacco screening not performed for medical reasons 4004F with 1P: Documentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reason)
Tobacco screening or tobacco cessation intervention not performed, reason not otherwise specified 4004F with 8P: Tobacco screening or tobacco cessation intervention not performed, reason not otherwise specified

Measure #325: Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions (Registry Reporting Only)
90791, 90832,
90834, 90837,
90845		 Performance met G8959:Clinician treating MDD communicates to clinician treating comorbid condition
Patient performance exclusion G9232: Clinician treating MDD did not communicate to clinician treating comorbid conditions for specified patient reason
Performance not met G8960: Clinician treating MDD did not communicate to clinician treating comorbid condition, reason not given

Measure #370: Depression Remission at 12 Months (Registry Reporting Only)
90791, 90792,
90832, 90834,
90837		 Index date PHQ-9 score greater than nine documented during the 12 month denominator identification period G9511
Performance met G9509: Remission at 12 months as demonstrated by a 12 month (+/-30 days) PHQ-9 score of less than five
Performance not met G9510: Remission at twelve months not demonstrated by a twelve month (+/-30 days) PHQ-9 score of less than five. Either PHQ-9 score was not assessed or is greater than or equal to five

#383: Adherence to Antipsychotic Medications for Individuals with Schizophrenia (Registry Reporting Only)
90785, 90791,
90832, 90834,
90837, 90845,
90847, 90849,
90853		 Performance met G9512: Individual had a PDC of 0.8 or greater. *New G code for 2016
Performance not met G9513: Individual did not have a PDC of 0.8 or greater. *New G code for 2016

#391: Follow-up After Hospitalization for Mental Illness (Registry Reporting or EHR Reporting Only)

#402: Tobacco Use and Help with Quitting Among Adolescents [age 12-20] (Registry Reporting Only)
90791, 90792, 90834, 90837, 90839, 90845, 96150, 96151, 96152 Performance met G9458: Patient documented as tobacco user and received tobacco cessation intervention (one of the following: advice given to quit smoking or tobacco use, counseling on benefits of quitting, assistance with or referral to external cessation support programs, current enrollment in smoking or tobacco cessation program)
Performance met G9459: Currently a tobacco nonuser
Performance not met G9460: Tobacco assessment or tobacco cessation intervention not performed, reason not given

#411:Depression Remission at Six Months (Registry Reporting Only)
90791, 90792,
90832, 90834,
90837		 Index date PHQ-9 score greater than nine documented during the 12 month denominator identification period G9572
Performance met G9573: Remission at six months as demonstrated by a six month (+/-30 days) PHQ-9 score of less than five
Performance not met G9574: Remission at six months not demonstrated by a six month (+/-30 days) PHQ-9 score of less than five. Either PHQ-9 score was not assessed or is greater than or equal to five

#431: Preventive Care and Screening: Unhealthy Alcohol Use and Brief Counseling (Registry Reporting Only)
90791, 90792,
90832, 90834,
90837, 90845,
96150, 96151,
96152		 Performance met G9621: Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling
Performance met G9622: Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
Medical performance exclusion G9623: Documentation of medical reason(s) for not screening for unhealthy alcohol use (e.g., limited life expectancy, other medical reasons)
Performance not met G9624: Patient not screened for unhealthy alcohol screening using a systematic screening method OR patient did not receive brief counseling, reason not given

Dementia Measures Group (Registry Reporting Only)
90791, 90832,
90834, 90837,
96116, 96120,
96150, 96151,
96152, 96154		 Measures groups are a subset of four or more PQRS measures that have a particular clinical condition or focus in common. All applicable measures within a group must be reported for each patient within the sample that meets the required criteria (such as age or gender) G Codes are reported by the registry
#47: Care Plan
#134 Preventive Care and Screening: Screening for Clinical Depression And Follow-Up Plan
#280: Dementia: Staging of Dementia
#281: Dementia: Cognitive Assessment
#282: Dementia: Functional Status Assessment
#283: Dementia: Neuropsychiatric Symptom Assessment
#284: Dementia: Management of Neuropsychiatric Symptoms
#286: Dementia: Counseling Regarding Safety Concerns
#287: Dementia: Counseling Regarding Risks of Driving
#288: Dementia: Caregiver Education and Support

Updated December 2015

Date created: 2015