CMS137v10 – Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Patients age 13 years of age and older who were diagnosed with a new episode of alcohol, opioid, or other drug abuse or dependency during a visit between January 1 and November 14 of the measurement period.

– NUMERATOR 1

Initiation of treatment includes either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis.

– NUMERATOR 2

Engagement in ongoing treatment within 34 days of initiation includes:

1. Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by a dispensed medication.
2. Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by two further psychosocial visits.
3. Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by both a further medication dispense and a psychosocial visit.
4. Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by two psychosocial visits.

 – DENOMINATOR EXCLUSIONS

• Exclude patients with a negative diagnosis history, defined as an encounter or medication treatment for a diagnosis of alcohol, opioid or other drug abuse or dependence in the 60 days prior to the first episode of alcohol or drug dependence.
• Exclude patients who are in hospice care for any part of the measurement period.

For Denominator:

Include patients aged 13 years or older with ‘first dependence diagnosis during the measurement period’.

For ‘First Dependence Diagnosis During Measurement Period’, the patient should have a qualifying encounter during the measurement period with ‘Alcohol and Drug Dependence’ diagnosis. The diagnosis prevalence period should start during the qualifying encounter and 47 days or more before the end of measurement period. The first dependence diagnosis must not be null.

• To record the ‘Alcohol and drug dependence’ diagnosis, use the workflow Patient > Provider Note > Diagnosis. Click ‘Add’ and search for the diagnosis. Add the diagnosis details and click ‘Save’. Then click ‘Accept’ and the diagnosis is added to the provider note.

• To record the qualifying encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.

For Numerator 1:

Include patients fulfilling any of the following criteria:

• Patients with “Treatment Initiation with Non-Medication Intervention”. Patient should have “Alcohol and Drug Dependence Treatment/ Psych visit – Psychotherapy” intervention or “Telephone Visits/Online Assessments” encounter performed 14 days or less after “First Dependence Diagnosis During the Measurement Period”.
  • To document the ‘Telephone Visits/Online Assessments’ encounter, use the workflow Patient > Provider Note > eSuperbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.
  • To record the diagnosis, navigate to Patient > Provider Note > Diagnosis.
  • To record the ‘Alcohol and drug dependence treatment’/’Psych Visit – Psychotherapy’ intervention, use the workflow Patient > Clinical > Evaluations. Click ‘+Add’ and search for an intervention. Select ‘Performed’ from the ‘Status’ dropdown and then click ‘Sign’ or ‘Save’.

• Patients with “Treatment Initiation with Medication Order”. For ‘Treatment Initiation with Medication Order’ patient should have ‘Opiate Antagonists’ medication ordered 14 days or less on or after day of start of ‘First dependence diagnosis during measurement period’.
  • To document the prescription, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Save’. Then click ‘Accept’ and the prescription is added to the provider note.

For Numerator 2:

Include patients fulfilling any of the following criteria in numerator 2:

• Patient having “Treatment with Single Medication Order during Measurement Period” 34 days or less after start of “Treatment Initiation with Non-Medication Intervention”.
  • To document a qualifying encounter or ‘Telephone Visit/Online Assessments’ encounter, use the workflow Patient > Provider Note > eSuperbill.
  • To record ‘Opiate Antagonists’ medication, use the workflow Patient > Provider Note > Prescription.
  • To record ‘Alcohol and Drug Dependence’ diagnosis, use the workflow Patient > Provider Note > Diagnosis.
  • To record the ‘Alcohol and drug dependence treatment’/’Psych Visit – Psychotherapy’ intervention, use the workflow Patient > Clinical > Evaluations.
• Patients with ‘Dependence Treatment Intervention Continued’. Patient should have two or more ‘Psychosocial Visit’ 34 days or less after start of ‘Treatment Initiation with Non-Medication Intervention’.
  • To document a qualifying encounter or ‘Telephone Visit/Online Assessments’ encounter, use the workflow Patient > Provider Note > eSuperbill.
  • To record the ‘Alcohol and drug dependence treatment’/’Psych Visit – Psychotherapy’ intervention, use the workflow Patient > Clinical > Evaluations.
  • To record the prescription, use the workflow Patient > Provider Note > Prescription.
• Patients with ‘Continuation of Treatment Event Following Medication Initiation’ and ‘Treatment with Single Medication Order During Measurement Period’ 34 days or less after ‘Treatment Initiation with Medication Order’.
  • To document a qualifying encounter or ‘Telephone Visit/Online Assessments’ encounter, use the workflow Patient > Provider Note > eSuperbill.
  • To record the ‘Alcohol and drug dependence treatment’/’Psych Visit – Psychotherapy’ intervention, use the workflow Patient > Clinical > Evaluations.
  • To record ‘Alcohol and Drug Dependence’ diagnosis, use the workflow Patient > Provider Note > Diagnosis.
  • To record ‘Opiate Antagonists’ medication, use the workflow Patient > Provider Note > Prescription.
• Patients should have two or more ‘Psychosocial Visit’ 34 days or less after “Treatment Initiation with Medication Order”.
  • To document a qualifying encounter or ‘Telephone Visit/Online Assessments’ encounter, use the workflow Patient > Provider Note > eSuperbill.
  • To record ‘Opiate Antagonists’ medication, use the workflow Patient > Provider Note > Prescription.
  • To record an intervention, use the workflow Patient > Clinical > Evaluations.
  • To record ‘Alcohol and Drug Dependence’ diagnosis, use the workflow Patient > Provider Note > Diagnosis.

Denominator Exclusions:

Exclude patients fulfilling any of the following conditions from the denominator:

• Patients who are in hospice care during the measurement year are included in denominator exclusion. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an intervention. Select ‘Order’ or ‘Performed’ from the ‘Status’ dropdown, then click ‘Sign’ or ‘Save’. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• • To document an encounter inpatient, navigate to Patient > Clinical > Evaluations

• Patient has ‘Alcohol and Drug Dependence Treatment/Psych Visit – Psychotherapy’ intervention performed 60 days or less before start of ‘First Dependence Diagnosis During Measurement Period’.
  • To record the ‘Alcohol and Drug Dependence Treatment/Psych Visit – Psychotherapy’ intervention, use the workflow Patient > Clinical > Evaluations.
  • To record a qualifying encounter, navigate to Patient > Provider Note > eSuperbill.
  • To record the ‘Alcohol and Drug Dependence’ diagnosis, navigate to Patient > Provider Note > Diagnosis.
• Patient has a qualifying encounter with diagnosis of ‘Alcohol and Drug Dependence’ 60 days or less before start of ‘First Dependence Diagnosis During Measurement Period’.
  • To record a qualifying encounter, navigate to Patient > Provider Note > eSuperbill.
  • To record the ‘Alcohol and Drug Dependence’ diagnosis, navigate to Patient > Provider Note > Diagnosis.
• Patient has ‘Opiate Antagonists’ medication ordered 60 days or less before start of ‘First Dependence Diagnosis During Measurement Period’.
  • To document the ‘Opiate Antagonists’ medication, navigate to Patient > Provider Note > Prescription.
  • To record a qualifying encounter, navigate to Patient > Provider Note > eSuperbill.
  • To record the ‘Alcohol and Drug Dependence’ diagnosis, navigate to Patient > Provider Note > Diagnosis.