CMS128v12 – Anti-depressant Medication Management

Patients 18 years of age and older as of April 30 of the measurement period who were dispensed antidepressant medications during Intake Period, and were diagnosed with major depression 60 days prior to, or 60 days after the dispensing event and had a visit 60 days prior to, or 60 days after the dispensing event.

Note: Intake Period refers to the time period starting from May 1 of the year prior to the measurement period to April 30 of the measurement period.

A qualifying visit can include any of the following:

• Office Visit
• Preventive Care Services Established Office Visit, 18 and Up
• Preventive Care Services Initial Office Visit, 18 and Up
• Home Healthcare Services
• Annual Wellness Visit
• Nursing Facility Visit
• Psych Visit Diagnostic Evaluation
• Psych Visit Psychotherapy
• Telephone Visits
• Online Assessments

Patients who have received antidepressant medication for at least 84 days (12 weeks) of continuous treatment beginning on IPSD (Index Prescription Start Dare) through 114 days after the IPSD (115 days in total).

Index Prescription Start Date (IPSD): The date of the earliest prescription dispensing event for an antidepressant medication during the Intake Period.

Same as Denominator 1

Patients who have received antidepressant medications for at least 180 days (6 months) of continuous treatment beginning on IPSD through 231 days after the IPSD (232 days in total).

Patients who fall in the following two categories are not included in the denominator:

• Patients who were actively on antidepressant medication in the 105 days prior to the IPSD.
• Patients who are in hospice care for any part of the measurement period.

For Denominator: 

• To document the diagnosis for major depression, use the workflow Patient > Provider Notes > Diagnoses and click ‘Add’. Search for the major depression diagnosis, add the diagnosis details and click ‘Save’.

• To record an encounter/visit, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, enter the encounter code.

• To prescribe antidepressant medication during the index prescription period, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the relevant medication. Fill out the relevant details. Once done, click ‘Prescribe’.

For Numerator 1 & 2:

• To document the medication, use the workflow Patient > Provider Notes > Medications or Patient > Provider Notes > Prescription. Click ‘Add’ and search for the medication. Complete the medication details and click ‘Save’.

For Denominator Exclusions:

• To document the antidepressant medication, use the workflow Patient > Provider Notes > Medications. Click ‘Add’ and search for the medication. Complete the medication details and press ‘Save’.

• To document that a patient is receiving hospice care outside of a hospital or long-term care facility, navigate to Patient > Provider Note > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• To document an inpatient encounter, navigate to Patient > Provider Note > Evaluations.

• To document a hospice care assessment, follow the workflow Patient > Provider Note > Evaluations. Click ‘Add’ and search for ‘Hospice Care [Minimum Data Set]’. Then select ‘Performed’ from the ‘Status’ dropdown and ‘Yes’ from the ‘Result’ field.

• A hospice encounter can be documented through Patient > Provider Note > Evaluations or Patient > Provider Note > Create Superbill.