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Source1

{
  "resourceType": "ValueSet",
  "id": "2.16.840.1.113762.1.4.1047.518",
  "meta": {
    "versionId": "13",
    "lastUpdated": "2024-06-20T01:22:57.000-04:00",
    "profile": [
      "http://hl7.org/fhir/StructureDefinition/shareablevalueset",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-valueset-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-valueset-cqfm"
    ]
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/valueset-author",
      "valueContactDetail": {
        "name": "ASRS Quality Measure Development Author"
      }
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/resource-lastReviewDate",
      "valueDate": "2024-06-20"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/valueset-effectiveDate",
      "valueDate": "2024-06-20"
    }
  ],
  "url": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.518",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113762.1.4.1047.518"
    }
  ],
  "version": "20240620",
  "name": "OphthalmologistVisit",
  "title": "Ophthalmologist visit",
  "status": "active",
  "date": "2024-06-20T01:22:57-04:00",
  "publisher": "ASRS Quality Measure Development Steward",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US"
        }
      ]
    }
  ],
  "purpose": "(Clinical Focus: This value set includes concepts related to ophthalmologist visits.),(Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.),(Inclusion Criteria: Includes relevant concepts associated with comprehensive history, evaluation, and management of a patient in an outpatient setting.),(Exclusion Criteria: No exclusions.)",
  "compose": {
    "include": [
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "concept": [
          {
            "code": "92002",
            "display": "Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient"
          },
          {
            "code": "92004",
            "display": "Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits"
          },
          {
            "code": "92012",
            "display": "Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient"
          },
          {
            "code": "92014",
            "display": "Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits"
          },
          {
            "code": "99201",
            "display": "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."
          },
          {
            "code": "99202",
            "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded."
          },
          {
            "code": "99203",
            "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded."
          },
          {
            "code": "99204",
            "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded."
          },
          {
            "code": "99205",
            "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded."
          },
          {
            "code": "99212",
            "display": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded."
          },
          {
            "code": "99213",
            "display": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded."
          },
          {
            "code": "99214",
            "display": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded."
          },
          {
            "code": "99215",
            "display": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded."
          },
          {
            "code": "99241",
            "display": "Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and 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, 15 minutes are spent face-to-face with the patient and/or family."
          },
          {
            "code": "99242",
            "display": "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded."
          },
          {
            "code": "99243",
            "display": "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded."
          },
          {
            "code": "99244",
            "display": "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded."
          },
          {
            "code": "99245",
            "display": "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded."
          },
          {
            "code": "99307",
            "display": "Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded."
          },
          {
            "code": "99308",
            "display": "Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded."
          },
          {
            "code": "99309",
            "display": "Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded."
          },
          {
            "code": "99310",
            "display": "Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded."
          },
          {
            "code": "99324",
            "display": "Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and 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 severity. Typically, 20 minutes are spent with the patient and/or family or caregiver."
          },
          {
            "code": "99325",
            "display": "Domiciliary or rest home 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; and 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 with the patient and/or family or caregiver."
          },
          {
            "code": "99326",
            "display": "Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and 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 with the patient and/or family or caregiver."
          },
          {
            "code": "99327",
            "display": "Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and 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 high severity. Typically, 60 minutes are spent with the patient and/or family or caregiver."
          },
          {
            "code": "99328",
            "display": "Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and 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 patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver."
          },
          {
            "code": "99334",
            "display": "Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval 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, 15 minutes are spent with the patient and/or family or caregiver."
          },
          {
            "code": "99335",
            "display": "Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused 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 low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver."
          },
          {
            "code": "99336",
            "display": "Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval 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, 40 minutes are spent with the patient and/or family or caregiver."
          },
          {
            "code": "99337",
            "display": "Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to 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. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver."
          }
        ]
      }
    ]
  },
  "expansion": {
    "identifier": "urn:uuid:a8940229-5590-4fde-9798-ffdbdcf19725",
    "timestamp": "2025-05-23T17:34:26-04:00",
    "total": 20,
    "contains": [
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "92002",
        "display": "Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient"
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "92004",
        "display": "Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits"
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "92012",
        "display": "Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient"
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "92014",
        "display": "Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits"
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99202",
        "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99203",
        "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99204",
        "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99205",
        "display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99212",
        "display": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99213",
        "display": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99214",
        "display": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99215",
        "display": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99242",
        "display": "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99243",
        "display": "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99244",
        "display": "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99245",
        "display": "Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99307",
        "display": "Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99308",
        "display": "Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99309",
        "display": "Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded."
      },
      {
        "system": "http://www.ama-assn.org/go/cpt",
        "version": "2025",
        "code": "99310",
        "display": "Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded."
      }
    ]
  }
}