Summary & Overview
CPT 4165F: Quality Measure Reporting Entry
CPT code 4165F denotes a performance measure entry used in quality reporting efforts across clinical settings. Though not a direct patient procedure, performance measure codes like 4165F matter nationally because they standardize how providers document adherence to clinical quality standards, inform value-based payment models, and support national quality benchmarking.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s purpose in quality reporting, its role in administrative and clinical workflows, and context on how such reporting measures intersect with national payment and quality programs. The publication outlines expected benchmarks and reporting considerations where available, summarizes policy and payer coverage themes affecting performance measure documentation, and provides clinical context for where and how the code is typically captured.
Data not available in the input for specific modifiers, associated taxonomies, linked ICD-10 diagnoses, and related service-line details.
Billing Code Overview
CPT code 4165F is listed without a formal summary. Based on its label, this code represents a performance measure entry used in quality reporting frameworks rather than a direct clinical procedure. Service type: Quality measurement/performance reporting. Typical site of service: Administrative or clinical settings where quality reporting is performed, such as outpatient clinics, hospital quality departments, and physician offices.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an otolaryngology clinic with chronic sinus symptoms, recurrent acute sinusitis, or nasal obstruction despite medical therapy. The clinician performs endoscopic evaluation and determines that an operative intervention is indicated to restore sinus ventilation and drainage or to address structural nasal issues. The workflow includes preoperative evaluation with history, nasal endoscopy, and imaging (CT sinus), informed consent, scheduling of outpatient or ambulatory surgery center operative time, intraoperative endoscopic sinus surgery using mucosal-sparing techniques and instrumentation, and immediate postoperative recovery with discharge instructions and short-interval follow-up for debridement and symptom assessment. Perioperative documentation includes operative report with procedure details, findings, estimated blood loss, anesthesia type, and any intraoperative complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
24 | Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period | Use when an E/M visit is provided for a condition unrelated to the postoperative care during the global period. |
25 | Significant, Separately Identifiable Evaluation and Management Service by Same Physician on Day of Procedure |