CMS159v10 – Depression Remission at Twelve Months

Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event).

– DENOMINATOR EXCLUSIONS:

• Patients who died
• Patients who received hospice or palliative care services
• Patients who were permanent nursing home residents
• Patients with a diagnosis of bipolar disorder
• Patients with a diagnosis of personality disorder emotionally labile
• Patients with a diagnosis of schizophrenia or psychotic disorder
• Patients with a diagnosis of pervasive developmental disorder

– NUMERATOR:

Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who achieved remission at twelve months as demonstrated by a twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five.

For Denominator:
Include adolescent patients 12 to 17 years of age and adult patients 18 years of age and older at the time of index assessment or during the index assessment period, with an ‘Index Depression Assessment’. For an ‘Index Depression Assessment’, the patient should have a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event).

• To document an encounter, navigate to Patient < Provider Note < eSuperbill. Under the ‘Procedure – CPTs’ heading, enter the encounter code. The encounter should end during ‘Denominator Identification Period’.

• To document major depression or dysthymia, use the workflow Patient < Provider Note < Diagnosis. Search for a diagnosis, enter the diagnosis details, and click ‘Save’. Then click ‘Accept’ and the diagnosis is added to the provider note.

• To document an assessment, navigate to Patient > Clinical > Evaluations. Click on ‘+ Evaluation’ and search for a depression assessment. Select ‘Performed’ from the ‘Status’ drop-down and enter a result in the ‘Result’ field. Then click ‘Save’ or ‘Sign’. The result must be greater than 9. Additionally, the depression assessment should be performed in the interval (start of depression encounter – 7 days to end of depression encounter). 

• Alternatively, to record an assessment navigate to Patient > Clinical > Assessments. Click ‘+Add’ and select the ‘PHQ-9’ assessment from the ‘Questionnaire’ dropdown. Then click ‘Search.

Select the assessment from the search results, complete the details, and click ‘Save’.

Note:

Denominator Identification Period:

The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. For patients with an index event, there needs to be enough time following index for the patients to have the opportunity to reach remission twelve months +/- 60 days after the index event date.  

Index Event Date: The date in which the first instance of elevated PHQ-9 or PHQ-9M greater than nine and diagnosis of depression or dysthymia occurs during the denominator identification measurement period. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event).

For Numerator:

Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who achieved remission at twelve months as demonstrated by a twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than 5. The patient should be assessed for depression remission during the measure assessment period. Use the workflow Patient > Clinical > Evaluations to add an assessment and its result. Click on ‘+ Evaluation’ and search for a depression assessment. Select ‘Performed’ from the ‘Status’ drop-down and enter a result in the ‘Result’ field. Then click ‘Save’ or ‘Sign’.

Alternatively, to record an assessment navigate to Patient > Clinical > Assessments. Click ‘+Add’ and select the ‘PHQ-9’ assessment from the ‘Questionnaire’ dropdown. Then click ‘Search.

Select the assessment from the search results, complete the details, and click ‘Save’.

Note:

Measure Assessment Period:

The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days) in length to allow for a follow-up PHQ-9 or PHQ-9M between 10 and 14 months following the index event. This assessment period is fixed and does not start over with a higher PHQ-9 or PHQ-9M that may occur after the index event date.

For Denominator Exclusions:

Patients satisfying any of the following conditions before the end of measure assessment period will be excluded from the Denominator.

• Palliative or Hospice Care Order.
  • Navigate to Patient > Clinical > Evaluations to order Palliative or Hospice Care intervention.
• Palliative Care Encounter.
  • Use the workflow Patient < Provider Note < eSuperbill to add Palliative Care encounter
• Long Term Care Encounter.
  • Use the workflow Patient < Provider Note < eSuperbill to add Care Services in Long-Term Residential Facility encounter.
• Patient Expired.
  • Navigate to the Patient module and click ‘Mark Inactive’. From the ‘Reason’ dropdown, select ‘Deceased’ and select expiration date from the ‘Expired On’ date picker. Then click ‘Save’.

• Disorder Diagnoses.
  • To document bipolar disorder, personality disorder, schizophrenia or psychotic disorder or pervasive developmental disorder, use the workflow Patient < Clinical < Diagnosis.