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CPT CodesWhat are CPT? II codes?Category II CPT? Codes are supplemental tracking codes used to measure performance. It is anticipated that the use of these codes will decrease the need for record abstraction and chart review and assist the provider in minimizing the administrative burden in measuring the quality of patient care. They are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures (HEDIS) and that have an evidence base as contributing to quality patient care. How are CPT? II codes developed?Category II codes are reviewed by the Performance Measures Advisory Group (PMAG), an advisory body to the CPT? Editorial Panel and the CPT?/HCPAC Advisory Committee. The PMAG is comprised of performance measurement experts representing the Agency for Healthcare Research and Quality (AHRQ), the American Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA), and the Physician Consortium for Performance Improvement. The PMAG may seek additional expertise and/or input from other national health care organizations, as necessary, for the development of tracking codes. These may include national medical specialty societies, other national health care professional associations, accrediting bodies, and federal regulatory agencies.Why should I use CPT? II codes?These codes describe clinical components that may be typically included in evaluation and management services or clinical services and, therefore, do not have a relative value associated with them. Category II codes may also describe results from clinical laboratory or radiology tests and other procedures, identified processes intended to address patient safety practices, or services reflecting compliance with state or federal law. The use of CPT? II codes can ease the administrative burden of chart retrieval and review for many of the HEDIS? performance measures throughout the year. Use of these codes enables your office to monitor internal performance of key measures throughout the service year. By identifying opportunities for improvement, interventions can be implemented to improve performance.Providers are not required to use these codes, as they are not required for the Correct Coding Initiatives and may not be used as a substitute for Category I codes.Where can I find a list of CPT? II Codes? CPT? II codes are released annually as part of the full CPT? code set and are updated semi-annually in January and July by the AMA. The current listing of CPT? II codes can be found on the AMA Website at do I bill CPT? II codes?CPT? Category II codes are arranged according to the following categories and are comprised of four digits followed by the letter “F”.Composite Measures 0001F-0015FPatient Management 0500F-0575FPatient History 1000F-1200FPhysical Examination 2000F-2050FDiagnostic/Screening Processes/Results 3006F-3573FTherapeutic, Preventive or Other Interventions 4000F-4306FFollow-up or Other Outcomes 5005F-5100FPatient Safety 6005F-6045FStructural Measures 7010F-7025FCPT? II codes describe clinical components that may be typically included in evaluation and management services or clinical services and, therefore, do not have a relative value associated with them. Therefore, CPT? II codes are billed with a $0.00 billable charge amount.How can my office use CPT? II codes to track our performance on specific HEDIS? measures?This is not a complete list of CPT? II category codes-refer to the AMA CPT Codes & Descriptions? for a full list. Refer to NCQA Volume 2 HEDIS Technical Specifications 2014 for a complete list of codes in the administrative specifications for each measure. STARs MeasureMeasure DescriptionIndicator DescriptionCPT? Category II CodesC01Breast Cancer ScreenMammography & results3014FC02Colorectal Screen3017FC03Cardiovascular Care- Cholesterol ScreeningLDL-C test & level3048F, 3049F, 3050FC04 Diabetes Care-Cholesterol ScreeningLDL-C test & level3048F, 3049F, 3050FC05Glaucoma TestingOptic Nerve evaluation2027F C06Annual Flu VaccineVaccine Administered/reported4274FC10Adult BMIBMI assessed/documented3008FC14Osteoporosis ManagementFemale plan members who broke a bone and got screening or treatment for osteoporosis within 6 months3095F, 3096F, 4005F,4019F C15Diabetes Care- Eye ExamRetinal Eye Exam2022F, 2024F, 2026 F, 3072FC16Diabetes Care- Kidney Disease MonitoringUrine Protein Screening3060F, 3061F, 3062F, 3066F, 4010FC17Diabetes Care-Blood Sugar ControlledHgA1c test & HgA1c Level3044F, 3045F,3046FC18Diabetes Care-Cholesterol ControlledLDL-C test & level3048F,3049F,3050FC19 Controlling Blood PressureBlood Pressure readingsSystolic Codes:3074F, 3075F3077F Diastolic Codes: 3078F, 3079F, 3080FC20Rheumatoid Arthritis ManagementPatients with Rheumatoid Arthritis who received 1 or more prescriptions for anti-rheumatics4187FCategory II CodeDescription2022FDilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed2024F7 standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed2026FEye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed2027FOptic nerve head evaluation performed3008FBody Mass Index (BMI), documented3014FScreening mammography results documented and reviewed 3017FColorectal cancer screening results documented and reviewed3044FMost recent hemoglobin A1c (HbA1c) level < 7.0%3045FMost recent hemoglobin A1c (HbA1c) level 7.0% to 9.0%3046FMost recent hemoglobin A1c (HbA1c) level > 9.0%3048FMost recent LDL-C < 100 mg/dL3049FMost recent LDL-C 100 - 129 mg/dL3050FMost recent LDL-C greater than or equal to 130 mg/dL3060FPositive microalbuminuria test result documented and reviewed3061FNegative microalbuminuria test result documented and reviewed3062FPositive macroalbuminuria test result documented and reviewed3066FDocumentation of treatment for nephropathy (eg, patient receiving dialysis, patient being treated for ESRD, CRF, ARF, or renal insufficiency, any visit to a nephrologist)3072FLow risk for retinopathy (no evidence of retinopathy in the prior year)3074FMost recent systolic blood pressure < 130 mm Hg3075FMost recent systolic blood pressure 130 to 139 mm Hg3077FMost recent systolic blood pressure ≥ 140 mm Hg3078FMost recent diastolic blood pressure < 80 mm Hg3079FMost recent diastolic blood pressure 80 - 89 mm Hg3080FMost recent diastolic blood pressure ≥ 90 mm Hg3095FDual-energy X-Ray Absorptiometry (DXA) results documented3096FCentral Dual-energy X-Ray Absorptiometry (DXA) ordered4005FPharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed4010FAngiotensin converting enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) therapy prescribed or currently being taken4013FStatin therapy prescribed or currently being taken4019FDocumentation of receipt of counseling on exercise AND either both calcium and vitamin D use or counseling regarding both calcium and vitamin D use4187FDisease modifying anti-rheumatic drug therapy prescribed, dispensed, or administered4274FInfluenza immunization administered or previously received ................
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