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CMS169v6 Code List

Code List: CMS169v6, Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use

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
Encounter Codes
Encounter, Performed: BH Outpatient Encounter: CPT 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245
Encounter, Performed: BH Outpatient Encounter: SNOMED 17436001, 183654001, 185211000, 185387006, 185389009, 30346009, 371883000, 37894004, 390906007, 40274000, 86013001, 90526000
Psychotherapy Encounter Codes
Encounter, Order: BH Outpatient Psychotherapy: CPT 90791, 90792, 90832, 90834, 90837
Encounter, Order: BH Outpatient Psychotherapy: SNOMED 108313002, 183382003, 183383008, 75516001, 76168009
Diagnosis Codes
Diagnosis: BH Condition Involving Bipolar Disorder: ICD-10 F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.73, F31.75, F31.77, F31.81, F31.89, F31.9, F34.0, F34.89
Diagnosis: BH Condition Involving Bipolar Disorder: SNOMED 10875004, 10981006, 1196001, 13313007, 13581000, 13746004, 14495005, 1499003, 162004, 16295005, 16506000, 17782008, 191583000, 191584006, 191586008, 191590005, 191592002, 191593007, 191595000, 191618007, 191620005, 191621009, 191623007, 191627008, 191629006, 191630001, 191632009, 191636007, 191638008, 191639000, 191641004, 191658009, 192362008, 19300006, 20960007, 21900002, 22407005, 231444002, 231494001, 231495000, 231496004, 26203008, 26530004, 268619003, 28663008, 28884001, 29929003, 30520009, 30687003, 31446002, 33380008, 34315001, 35481005, 35722002, 35846004, 36583000, 371596008, 371599001, 371600003, 371604007, 40926005, 41552001, 41832009, 41932008, 43568002, 43769008, 4441000, 45479006, 46229002, 48937005, 49468007, 49512000, 51637008, 53049002, 53607008, 54761006, 55516002, 5703000, 59617007, 61403008, 63249007, 64731001, 65042007, 66631006, 67002003, 68569003, 70546001, 71294008, 71984005, 73471000, 74686005, 75360000, 75752004, 76105009, 78269000, 78640000, 79584002, 81319007, 82998009, 83225003, 85248005, 86058007, 87203005, 87950005, 9340000
Diagnosis: BH Condition Involving Unipolar Depression: ICD-10 F32.0, F32.1, F32.2, F32.3, F32.4, F32.81, F32.89, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.8, F33.9, F34.1
Diagnosis: BH Condition Involving Unipolar Depression: SNOMED 14183003, 15193003, 15639000, 18818009, 191610000, 191611001, 191613003, 19527009, 20250007, 25922000, 2618002, 268621008, 28475009, 30605009, 319768000, 320751009, 33078009, 33135002, 33736005, 35489007, 36474008, 36923009, 370143000, 38694004, 39809009, 40379007, 42810003, 42925002, 430852001, 46244001, 60099002, 63412003, 63778009, 66344007, 68019004, 69392006, 70747007, 71336009, 73867007, 75084000, 76441001, 77911002, 78667006, 79298009, 832007, 87512008
Treatment Procedure Codes
Procedure, Order: BH Electroconvulsive therapy: CPT 90870
Procedure, Order: BH Electroconvulsive therapy: SNOMED 11075005, 231079005, 231080008, 23835007, 284468008, 313019002, 313020008
Procedure, Order: BH Counseling for depression: SNOMED 428201000124103
Treatment Medications
Medication, Active: BH Antidepressant medication: Description (RXNORM code) 12 HR Bupropion Hydrochloride 100 MG Extended Release Oral Tablet (993503); 12 HR Bupropion Hydrochloride 150 MG Extended Release Oral Tablet (993518); 12 HR Bupropion Hydrochloride 200 MG Extended Release Oral Tablet (993536); 24 HR Bupropion hydrobromide 174 MG Extended Release Oral Tablet (993550); 24 HR Bupropion hydrobromide 348 MG Extended Release Oral Tablet (993567); 24 HR Bupropion hydrobromide 522 MG Extended Release Oral Tablet (993681); 24 HR Bupropion Hydrochloride 150 MG Extended Release Oral Tablet (993541); 24 HR Bupropion Hydrochloride 300 MG Extended Release Oral Tablet (993557); 24 HR Bupropion Hydrochloride 450 MG Extended Release Oral Tablet (1232585); 24 HR Desvenlafaxine 100 MG Extended Release Oral Tablet (790264); 24 HR Desvenlafaxine 50 MG Extended Release Oral Tablet (790288); 24 HR Fluvoxamine Maleate 100 MG Extended Release Oral Capsule (903873); 24 HR Fluvoxamine Maleate 150 MG Extended Release Oral Capsule (903879); 24 HR Selegiline 0.25 MG/HR Transdermal System (865206); 24 HR Selegiline 0.375 MG/HR Transdermal System (865210); 24 HR Selegiline 0.5 MG/HR Transdermal System (865214); 24 HR Trazodone Hydrochloride 150 MG Extended Release Oral Tablet (898697); 24 HR Trazodone Hydrochloride 300 MG Extended Release Oral Tablet (898704); 24 HR venlafaxine 150 MG Extended Release Oral Capsule (313581); 24 HR venlafaxine 150 MG Extended Release Oral Tablet (808744); 24 HR venlafaxine 225 MG Extended Release Oral Tablet (808748); 24 HR venlafaxine 37.5 MG Extended Release Oral Capsule (313583); 24 HR venlafaxine 37.5 MG Extended Release Oral Tablet (808751); 24 HR venlafaxine 75 MG Extended Release Oral Capsule (313585); 24 HR venlafaxine 75 MG Extended Release Oral Tablet (808753); Amitriptyline Hydrochloride 10 MG / Perphenazine 2 MG Oral Tablet (856706); Amitriptyline Hydrochloride 10 MG / Perphenazine 4 MG Oral Tablet (856720); Amitriptyline Hydrochloride 10 MG Oral Tablet (856783); Amitriptyline Hydrochloride 100 MG Oral Tablet (856762); Amitriptyline Hydrochloride 12.5 MG / Chlordiazepoxide 5 MG Oral Tablet (856769); Amitriptyline Hydrochloride 150 MG Oral Tablet (856773); Amitriptyline Hydrochloride 25 MG / Chlordiazepoxide 10 MG Oral Tablet (856792); Amitriptyline Hydrochloride 25 MG / Perphenazine 2 MG Oral Tablet (856797); Amitriptyline Hydrochloride 25 MG / Perphenazine 4 MG Oral Tablet (856825); Amitriptyline Hydrochloride 25 MG Oral Tablet (856834); Amitriptyline Hydrochloride 50 MG / Perphenazine 4 MG Oral Tablet (856840); Amitriptyline Hydrochloride 50 MG Oral Tablet (856845); Amitriptyline Hydrochloride 75 MG Oral Tablet (856853); Amoxapine 100 MG Oral Tablet (197363); Amoxapine 150 MG Oral Tablet (197364); Amoxapine 25 MG Oral Tablet (197365); Amoxapine 50 MG Oral Tablet (197366); Bupropion Hydrochloride 100 MG Oral Tablet (993687); Bupropion Hydrochloride 75 MG Oral Tablet (993691); Citalopram 10 MG Oral Capsule (730440); Citalopram 10 MG Oral Tablet (283672); Citalopram 2 MG/ML Oral Solution (309313); Citalopram 20 MG Oral Capsule (730441); Citalopram 20 MG Oral Tablet (200371); Citalopram 40 MG Oral Capsule (730442); Citalopram 40 MG Oral Tablet (309314); Clomipramine Hydrochloride 10 MG Oral Tablet (857291); Clomipramine Hydrochloride 25 MG Oral Capsule (857297); Clomipramine Hydrochloride 25 MG Oral Tablet (857296); Clomipramine Hydrochloride 50 MG Oral Capsule (857301); Clomipramine Hydrochloride 50 MG Oral Tablet (857315); Clomipramine Hydrochloride 75 MG Oral Capsule (857305); Desipramine Hydrochloride 10 MG Oral Tablet (1099288); Desipramine Hydrochloride 100 MG Oral Tablet (1099292); Desipramine Hydrochloride 150 MG Oral Tablet (1099296); Desipramine Hydrochloride 25 MG Oral Tablet (1099300); Desipramine Hydrochloride 50 MG Oral Tablet (1099304); Desipramine Hydrochloride 75 MG Oral Tablet (1099316); Dothiepin 25 MG Oral Capsule (199461); Dothiepin 75 MG Oral Tablet (199462); Doxepin 3 MG Oral Tablet (966787); Doxepin 6 MG Oral Tablet (966793); Doxepin Hydrochloride 10 MG Oral Capsule (1000048); Doxepin Hydrochloride 10 MG/ML Oral Solution (1000054); Doxepin Hydrochloride 100 MG Oral Capsule (1000058); Doxepin Hydrochloride 150 MG Oral Capsule (1000064); Doxepin Hydrochloride 25 MG Oral Capsule (1000070); Doxepin Hydrochloride 50 MG Oral Capsule (1000076); Doxepin Hydrochloride 50 MG/ML Topical Cream (1000091); Doxepin Hydrochloride 75 MG Oral Capsule (1000097); duloxetine 20 MG Delayed Release Oral Capsule (596926); duloxetine 30 MG Delayed Release Oral Capsule (596930); duloxetine 60 MG Delayed Release Oral Capsule (596934); Escitalopram 1 MG/ML Oral Solution (351285); Escitalopram 10 MG Oral Tablet (349332); Escitalopram 20 MG Oral Tablet (351250); Escitalopram 5 MG Oral Tablet (351249); Fluoxetine 10 MG Oral Capsule (310384); Fluoxetine 10 MG Oral Tablet (313990); Fluoxetine 20 MG Oral Capsule (310385); Fluoxetine 20 MG Oral Tablet (248642); Fluoxetine 25 MG / olanzapine 12 MG Oral Capsule (403970); Fluoxetine 25 MG / olanzapine 3 MG Oral Capsule (721787); Fluoxetine 25 MG / olanzapine 6 MG Oral Capsule (403969); Fluoxetine 4 MG/ML Oral Solution (310386); Fluoxetine 40 MG Oral Capsule (313989); Fluoxetine 50 MG / olanzapine 12 MG Oral Capsule (403971); Fluoxetine 50 MG / olanzapine 6 MG Oral Capsule (403972); Fluoxetine 60 MG Oral Tablet (1190110); Fluoxetine 90 MG Delayed Release Oral Capsule (313995); Fluvoxamine Maleate 100 MG Oral Tablet (903884); Fluvoxamine Maleate 25 MG Oral Tablet (903887); Fluvoxamine Maleate 50 MG Oral Tablet (903891); Imipramine Hydrochloride 10 MG Oral Tablet (835593); Imipramine Hydrochloride 25 MG Oral Tablet (835564); Imipramine Hydrochloride 50 MG Oral Tablet (835568); Imipramine pamoate 100 MG Oral Capsule (835591); Imipramine pamoate 125 MG Oral Capsule (835589); Imipramine pamoate 150 MG Oral Capsule (835577); Imipramine pamoate 75 MG Oral Capsule (835572); Isocarboxazid 10 MG Oral Tablet (104837); Lithium Aspartate 20 MG Oral Capsule (749153); Lithium Aspartate 5 MG Oral Capsule (746073); Lithium Carbonate 150 MG Oral Capsule (311355); Lithium Carbonate 250 MG Oral Tablet (199324); Lithium Carbonate 300 MG Extended Release Oral Tablet (197891); Lithium Carbonate 300 MG Oral Capsule (197889); Lithium Carbonate 300 MG Oral Tablet (197890); Lithium Carbonate 400 MG Oral Tablet (199761); Lithium Carbonate 450 MG Extended Release Oral Tablet (197892); Lithium Carbonate 600 MG Oral Capsule (197893); lithium citrate 60 MG/ML Oral Solution (756059); lithium orotate 5 MG Oral Capsule (846386); Maprotiline Hydrochloride 25 MG Oral Tablet (1298857); Maprotiline Hydrochloride 50 MG Oral Tablet (1298861); Maprotiline Hydrochloride 75 MG Oral Tablet (1298870); Mianserin 10 MG Oral Tablet (199484); Mianserin 20 MG Oral Tablet (199485); Milnacipran hydrochloride 100 MG Oral Tablet (833135); Milnacipran hydrochloride 12.5 MG Oral Tablet (833141); Milnacipran hydrochloride 25 MG Oral Tablet (833147); Milnacipran hydrochloride 50 MG Oral Tablet (833144); Mirtazapine 15 MG Disintegrating Oral Tablet (283406); Mirtazapine 15 MG Oral Tablet (311725); Mirtazapine 30 MG Disintegrating Oral Tablet (283407); Mirtazapine 30 MG Oral Tablet (314111); Mirtazapine 45 MG Disintegrating Oral Tablet (283485); Mirtazapine 45 MG Oral Tablet (311726); Mirtazapine 7.5 MG Oral Tablet (476809); Moclobemide 100 MG Oral Tablet (246588); Moclobemide 150 MG Oral Tablet (199487); Moclobemide 300 MG Oral Tablet (199488); Nefazodone hydrochloride 100 MG Oral Tablet (1098649); Nefazodone hydrochloride 150 MG Oral Tablet (1098666); Nefazodone hydrochloride 200 MG Oral Tablet (1098670); Nefazodone hydrochloride 250 MG Oral Tablet (1098674); Nefazodone hydrochloride 50 MG Oral Tablet (1098678); Nortriptyline 10 MG Oral Capsule (198045); Nortriptyline 10 MG Oral Tablet (199283); Nortriptyline 2 MG/ML Oral Solution (312036); Nortriptyline 25 MG Oral Capsule (317136); Nortriptyline 50 MG Oral Capsule (198046); Nortriptyline 75 MG Oral Capsule (198047); Paroxetine Hydrochloride 10 MG Oral Tablet (1738483); Paroxetine Hydrochloride 2 MG/ML Oral Suspension (312242); Paroxetine Hydrochloride 20 MG Oral Tablet (1738495); Paroxetine Hydrochloride 30 MG Oral Tablet (1738503); Paroxetine Hydrochloride 40 MG Oral Tablet (1738511); Paroxetine mesylate 10 MG Oral Tablet (1738515); Paroxetine mesylate 20 MG Oral Tablet (1738519); Paroxetine mesylate 30 MG Oral Tablet (1738523); Paroxetine mesylate 40 MG Oral Tablet (1738527); Phenelzine 15 MG Oral Tablet (312347); Protriptyline Hydrochloride 10 MG Oral Tablet (905168); Protriptyline Hydrochloride 5 MG Oral Tablet (905172); rasagiline 0.5 MG Oral Tablet (636664); rasagiline 1 MG Oral Tablet (608328); selegiline hydrochloride 1.25 MG Disintegrating Oral Tablet (859190); selegiline hydrochloride 5 MG Oral Capsule (859186); selegiline hydrochloride 5 MG Oral Tablet (859193); Sertraline 100 MG Oral Tablet (312938); Sertraline 150 MG Oral Tablet (794947); Sertraline 20 MG/ML Oral Solution (861064); Sertraline 200 MG Oral Tablet (251200); Sertraline 25 MG Oral Tablet (312940); Sertraline 50 MG Oral Tablet (312941); Tranylcypromine 10 MG Oral Tablet (313447); Trazodone Hydrochloride 100 MG Oral Tablet (856373); Trazodone Hydrochloride 150 MG Oral Tablet (856364); Trazodone Hydrochloride 300 MG Oral Tablet (856369); Trazodone Hydrochloride 50 MG Oral Tablet (856377); Trimipramine 100 MG Oral Capsule (313496); Trimipramine 100 MG Oral Tablet (313497); Trimipramine 25 MG Oral Capsule (313498); Trimipramine 25 MG Oral Tablet (199820); Trimipramine 50 MG Oral Capsule (313499); Trimipramine 50 MG Oral Tablet (245373); venlafaxine 100 MG Oral Tablet (313580); venlafaxine 25 MG Oral Tablet (313582); venlafaxine 37.5 MG Oral Tablet (313584); venlafaxine 50 MG Oral Tablet (314277); venlafaxine 75 MG Oral Tablet (313586)
Medication, Active: BH Mood stabilizer medication: Description (RXNORM code) Clozapine 100 MG Disintegrating Oral Tablet (476177); Clozapine 100 MG Oral Tablet (197535); Clozapine 12.5 MG Disintegrating Oral Tablet (721773); Clozapine 150 MG Disintegrating Oral Tablet (1006801); Clozapine 200 MG Disintegrating Oral Tablet (996921); Clozapine 200 MG Oral Tablet (309374); Clozapine 25 MG Disintegrating Oral Tablet (476179); Clozapine 25 MG Oral Tablet (197536); Clozapine 50 MG Oral Tablet (429212); fluphenazine decanoate 25 MG/ML Injectable Solution (859824); iloperidone 1 MG Oral Tablet (848722); iloperidone 10 MG Oral Tablet (848728); iloperidone 12 MG Oral Tablet (848732); iloperidone 2 MG Oral Tablet (848736); iloperidone 4 MG Oral Tablet (848740); iloperidone 6 MG Oral Tablet (848744); iloperidone 8 MG Oral Tablet (848748); oxcarbazepine 150 MG Oral Tablet (312136); oxcarbazepine 300 MG Oral Tablet (312137); oxcarbazepine 60 MG/ML Oral Suspension (283536); oxcarbazepine 600 MG Oral Tablet (312138); Perphenazine 16 MG Oral Tablet (198075); Perphenazine 2 MG Oral Tablet (198076); Perphenazine 4 MG Oral Tablet (198077); Perphenazine 8 MG Oral Tablet (198078); topiramate 100 MG Oral Tablet (199889); topiramate 15 MG Oral Capsule (205316); topiramate 200 MG Oral Tablet (199890); topiramate 25 MG Oral Capsule (205315); topiramate 25 MG Oral Tablet (199888); topiramate 50 MG Oral Tablet (151226)
Encounter Assessment Codes
Procedure, Performed: BH Assessment for alcohol or other drugs: HCPCS H0001, H0049
Procedure, Performed: BH Assessment for alcohol or other drugs: CPT 99408, 99409
Procedure, Performed: BH Assessment for alcohol or other drugs: SNOMED 105355005, 117251007, 171208001, 252170002, 273347006, 408942001, 408946003, 428211000124100

Last updated: June 29, 2018 at 1:41 pm