Quick reference guide for 2015 PQRS measures, procedure codes and G-codes

By Government Relations staff

The Physician Quality Reporting System (PQRS) is Medicare’s reporting program whereby health care professionals, including psychologists, submit data on specified quality measures to the Centers for Medicare and Medicaid Services (CMS). PQRS reporting 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.

The charts below provide an overview of the PQRS measures (in orange), applicable procedure codes and G-codes available for each measure. It includes measures available for claims-based and registry reporting. Prior to using this chart, psychologists will need to determine which measure is applicable by examining their Medicare population and identifying those beneficiaries for whom available PQRS measures would apply.

Psychologists should note that for 2015 some measures previously available for claims-based reporting have been changed to Electronic Health Record (EHR) reporting or Registry reporting only. Those available for Registry reporting only appear in the chart below.

The following measures are now limited to EHR reporting only:

Measure #9: Major depressive disorder (MDD): Antidepressant medication during acute phase for patients with MDD.
Measure #107: Major depressive disorder: Suicide risk assessment.

Other PQRS measures formerly available have been eliminated altogether for 2015, including:

Measure #106: Major depressive disorder: Diagnostic evaluation.
Measure #247: Substance use disorders: Counseling.
Measure #248: Substance use disorders: Screening for depression.

For additional materials and resources related to PQRS, visit the Quality Improvement Programs section at the APA Practice Organization’s Practice Central website.

Measure #128: Preventive care and screening: Body mass index screening and follow-up

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
90791 90832 90834 90837 90839 96150 96151 96152	BMI calculated as normal, no follow-up plan required	G8420: Calculated BMI within normal parameters and documented
	BMI calculated above normal parameters, follow-up documented	G8417: Calculated BMI above normal parameters and a follow-up is documented
	BMI calculated below normal parameters, follow-up documented	G8418: Calculated BMI below normal parameters and a follow-up plan is documented
	BMI not calculated, patient not eligible/not appropriate	G8422: Patient not eligible for BMI calculation
	BMI calculated, patient not eligible/not appropriate for follow-up plan	G8938: BMI is calculated, but patient not eligible for follow-up plan
	BMI not calculated, reason not given	G8421: BMI not calculated no reason given
	BMI calculated outside normal parameters, follow-up plan not documented, reason not given	G8419: Calculated BMI outside normal parameters, no follow-up plan documented

Measure #130: Documentation and verification of current medications in the medical record

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
90791 90832 90834 90837 90839 96116 96150 96151 96152	Current medications documented	G8427: Eligible professional attests to documenting the patient’s
	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 by the eligible professional, reason not given

Measure #131: Pain assessment prior to initiation of patient therapy and follow-up

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
90791 96116 96118 96150 96151	Pain assessment documented as positive	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
	Patient not eligible for pain assessment for documented reasons	G8442: Documentation that patient is not eligible for a pain assessment
	Pain assessment documented, follow-up plan not documented, patient not eligible/appropriate	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

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
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/appropriate	G8433: Screening for clinical depression not documented, patient not eligible/appropriate
	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/appropriate
	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 (Registry Reporting Only)

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
90791 90832 90834 90837 90845 96150 96151 96152	Patient screened for unhealthy alcohol uses using a systematic screening method	CPT II 3016F
	Unhealthy alcohol use screening not performed, for medical reasons	3016F with 1P: Documentation of medical reason(s) for not screening for unhealthy alcohol use (eg, limited life expectancy, other medical reasons)
	Unhealthy alcohol use screening not performed, reason not otherwise specified	3016F with 8P: Unhealthy alcohol use screening not performed, reason not otherwise specified

Measure #181: Elder Maltreatment screen and follow-up plan

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
90791 90832 90834 90837 96116 96150 96151	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 assessment and tobacco cessation

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
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 #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (Follow-up includes referral to alternative/primary care provider)

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
90791 90832 90834 90837 90839 90845 90880 96118	Performance met	G8783: Normal blood pressure reading documented; follow-up not required
	Performance met	G8950: Pre-hypertensive or hypertensive blood pressure reading documented, AND the indicated follow-up is documented
	Performance exclusion	G8784: Blood pressure reading not documented, documentation the patient is not eligible
	Performance exclusion	G8951: Pre-hypertensive or hypertensive blood pressure reading documented, Indicated follow-up not documented, documentation the patient is not eligible
	Performance not met	G8785: Blood pressure reading not documented, reason not given
	Performance not met	G8952: Pre-hypertensive or hypertensive blood pressure reading documented,indicated follow-up not documented, reason not given

Measure #325: Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions (Registry Reporting Only)

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
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 #383: Adherence to Antipsychotic Medications for Individuals with Schizophrenia (Registry Reporting Or EHR Reporting Only)

Applicable Procedure Codes	Action Taken	G-Code (or F-code where applicable)
90785, 90791 90832, 90834 90837, 90845 90847, 90849 90853	Performance met	G9369: Individual filled at least two prescriptions for any antipsychotic medication and had a PDC of 0.8 or greater
90785, 90791 90832, 90834 90837, 90845 90847, 90849 90853	Performance not met	G9370: Individual did not fill at least two prescriptions of any antipsychotic medication and did not have a PDC of 0.8 or greater

Dementia Measures Group (Registry Reporting Only)

Applicable Procedure Codes
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
	#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
	#285: Dementia: Screening for Depressive Symptoms
	#286: Dementia: Counseling Regarding Safety Concerns
	#287: Dementia: Counseling Regarding Risks of Driving
	#288: Dementia: Caregiver Education and Support

Quick reference guide for PQRS measures, procedure codes and G-codes