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CMS52v6 Code List

Code List: CMS 52v6, HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) prophylaxis

MicroMD uses the following code lists to determine a patient’s inclusion in this measure.  To search for your code, simply press Ctrl + F on your keyboard, enter your code in the search field and press Enter on your keyboard.

This user-friendly code list is provided as a courtesy to our MicroMD users.  For more in-depth information about codes and/or criteria or to compare version changes, visit the CMS eCQI Resource Center at https://ecqi.healthit.gov/ (no user account required) or the United States Health Information Knowledgebase at https://ushik.ahrq.gov/mdr/portals (requires a free user account to view codes).

Item Codes
Diagnosis Codes
Diagnosis: HIV 1: ICD-9 042, V08
Diagnosis: HIV 1: ICD-10 B20, Z21
Diagnosis: HIV 1: SNOMED 5810003, 40780007, 48794007, 52079000, 62246005, 62479008, 77070006, 79019005, 86406008, 87117006, 91947003, 91948008, 111880001, 186706006, 186707002, 186708007, 186709004, 186717007, 186718002, 186719005, 186721000, 186723002, 186725009, 186726005, 230180003, 230201009, 230598008, 235009000, 235726002, 240103002, 276666007, 315019000, 359791000, 397763006, 398329009, 402915006, 402916007, 405631006, 713260006, 713275003, 713278001, 713297001, 713298006, 713299003, 713300006, 713316008, 713318009, 713320007, 713325002, 713339002, 713340000, 713341001, 713342008, 713349004, 713444005, 713445006, 713446007, 713483007, 713484001, 713487008, 713488003, 713489006, 713490002, 713491003, 713497004, 713503007, 713504001, 713505000, 713506004, 713507008, 713508003, 713510001, 713511002, 713523008, 713526000, 713527009, 713530002, 713531003, 713532005, 713533000, 713543002, 713544008, 713545009, 713546005, 713570009, 713571008, 713572001, 713695001, 713696000, 713718006, 713722001, 713729005, 713730000, 713731001, 713732008, 713733003, 713734009, 713844000, 713845004, 713880000, 713881001, 713887002, 713897006, 713964006, 713967004, 714083007, 714464009
Encounter Codes
Encounter, Performed: Face-to-Face Interaction: SNOMED 12843005, 18170008, 19681004, 87790002, 90526000, 185349003, 185463005, 185465003, 207195004, 270427003, 270430005, 308335008, 390906007, 406547006, 439708006
Encounter, Performed: Office Visit: CPT 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215
Encounter, Performed: Outpatient Consultation: CPT 99241, 99242, 99243, 99244, 99245
Encounter, Performed: Preventive Care – Established Office Visit, 0 to 17: CPT 99391, 99392, 99393, 99394
Encounter, Performed: Preventive Care – Initial Office Visit, 0 to 17: CPT 99381, 99382, 99383, 99384
Encounter, Performed: Preventive Care – Established Office Visit, 18 and up: CPT 99395, 99396, 99397
Encounter, Performed: Preventive Care – Initial Office Visit, 18 and up: CPT 99385, 99386, 99387
Laboratory LOINC Codes
Laboratory Test, Performed: CD4+ Count: LOINC 24467-3, 32515-9, 32532-4, 40898-9, 63450-1
Laboratory Test, Performed: CD4+ Percentage: LOINC 8123-2, 17822-8, 32516-7, 32533-2, 40623-1, 43970-3, 51300-2
Medications
Medication, Order: Leucovorin: Description (RXNORM Code) Leucovorin 5 MG Oral Tablet (197863); Leucovorin 10 MG Oral Tablet (197860); Leucovorin 10 MG/ML Injectable Solution (311282); Leucovorin 15 MG Oral Tablet (197861); Leucovorin 25 MG Oral Tablet (197862); Leucovorin 350 MG Injection (237788)
Medication, Order: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis: Description (RXNORM Code) Atovaquone 150 MG/ML Oral Suspension (308429); Dapsone 0.05 MG/MG Topical Gel (607295); Dapsone 100 MG Oral Tablet (197557); Dapsone 25 MG Oral Tablet (197558); Pentamidine Isethionate 50 MG/ML Inhalant Solution (861597); Pyrimethamine 25 MG / Sulfadoxine 500 MG Oral Tablet (198229); Sulfamethoxazole 100 MG / Trimethoprim 20 MG Oral Tablet (142118); Sulfamethoxazole 40 MG/ML / Trimethoprim 8 MG/ML Oral Suspension (313134); Sulfamethoxazole 400 MG / Trimethoprim 80 MG Oral Tablet (198334); Sulfamethoxazole 80 MG/ML / Trimethoprim 16 MG/ML Injectable Solution (313137); Sulfamethoxazole 800 MG / Trimethoprim 160 MG Oral Tablet (198335)
Medication, Order: Dapsone and pyrimethamine: Description (RXNORM Code) Dapsone 100 MG / Pyrimethamine 12.5 MG Oral Tablet (105337)
Exclusion Codes
Encounter, Performed: Encounter Inpatient 183452005, 32485007, 8715000
Intervention, Order: Hospice Care 385763009, 385765002
Discharge Codes to Health Care Facility for Hospice Care  428371000124100
Discharge Codes to Home for Hospice Care  428361000124107

Last updated:  May 7, 2018 2:54 PM