Midas DataVision and CPMS Core Measures Appendices for Hospital-Based Inpatient Psychiatric Services (HBIPS), Perinatal Care (PC), Stroke (STK), Comprehensive Stroke (CSTK) Excerpts from the Specifications Manual for Joint Commission National Quality Core Measures, v2017B2 Encounters discharged July 1, 2017 – December 31, 2017 Acknowledgment The Specifications Manual for Joint Commission National Quality Core Measures is periodically updated by the Joint Commission. Users of the Specifications Manual must update their software and associated documentation based on the published manual production timelines. Midas Health Analytics Solutions CONDUENT 4801 East Broadway Blvd, Suite 200 Tucson, Arizona 85711 (877) 414-2676 www.conduent.com BR435 Appendix A ICD-10 Code Tables Table Number 1.0: Outpatient (E/M codes) Code Shortened Description 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or 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 patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. 99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or 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 patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. 99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or 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 patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. 99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or 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 patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. 99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or 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 patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or 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 patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. Specifications Manual for Joint Commission National Quality Measures v2017B2 720 Discharges 01-01-18 (1Q18) through 06-30-18 (2Q18) Code Shortened Description 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. 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 patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family. 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or 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 patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or 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 patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. Table Number 2.1: Heart Failure Code Shortened Description I110 Hypertensive heart disease with heart failure I130 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease I132 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease I501 Left ventricular failure, unspecified I5020 Unspecified systolic (congestive) heart failure I5021 Acute systolic (congestive) heart failure I5022 Chronic systolic (congestive) heart failure I5023 Acute on chronic systolic (congestive) heart failure I5030 Unspecified diastolic (congestive) heart failure I5031 Acute diastolic (congestive) heart failure I5032 Chronic diastolic (congestive) heart failure I5033 Acute on chronic diastolic (congestive) heart failure I5040 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure I5041 Acute combined systolic (congestive) and diastolic (congestive) heart failure Specifications Manual for Joint Commission National Quality Measures v2017B2 721 Discharges 01-01-18 (1Q18) through 06-30-18 (2Q18) Code Shortened Description I5042 Chronic combined systolic (congestive) and diastolic (congestive) heart failure I5043 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure I50810 Right heart failure, unspecified I50811 Acute right heart failure I50812 Chronic right heart failure I50813 Acute on chronic right heart failure I50814 Right heart failure due to left heart failure I5082 Biventricular heart failure I5083 High output heart failure I5084 End stage heart failure I5089 Other heart failure I509 Heart failure, unspecified Table Number 2.2: Left Ventricular Assistive Device (LVAD) and Heart Transplant Code Shortened Description 02HA0QZ Insertion of Implantable Heart Assist System into Heart, Open Approach 02HA0RJ Insertion of Short-term External Heart Assist System into Heart, Intraoperative, Open Approach 02HA0RS Insertion of Biventricular Short-term External Heart Assist System into Heart, Open Approach 02HA0RZ Insertion of Short-term External Heart Assist System into Heart, Open Approach 02HA3QZ Insertion of Implantable Heart Assist System into Heart, Percutaneous Approach 02HA3RJ Insertion of Short-term External Heart Assist System into Heart, Intraoperative, Percutaneous Approach 02HA3RS Insertion of Biventricular Short-term External Heart Assist System into Heart, Percutaneous Approach 02HA3RZ Insertion of Short-term External Heart Assist System into Heart, Percutaneous Approach 02HA4QZ Insertion of Implantable Heart Assist System into Heart, Percutaneous Endoscopic Approach 02HA4RJ Insertion of Short-term External Heart Assist System into Heart, Intraoperative, Percutaneous Endoscopic Approach 02HA4RS Insertion of