CMS137v12 – Initiation and Engagement of Substance Use Disorder Treatment

Patients 13 years of age and older as of the start of the measurement period who were diagnosed with a new SUD (Substance Use Disorder) episode during a visit between January 1 and November 14 of the measurement period.

Note: The patient should not have a History of SUD Diagnosis or Treatment. Their first SUD episode must have occurred during the visit within the measurement period.

A qualifying encounter for denominator can include any of the following:

• Office Visit
• Emergency Department Visit
• Detoxification Visit
• Initial Hospital Observation Care
• Initial Hospital Inpatient Visit
• Discharge Services Hospital Inpatient Same Day Discharge
• Discharge Services Hospital Inpatient
• Telephone Visits
• Online Assessments

– NUMERATOR 1

Initiation of treatment includes either an intervention or medication for the treatment of SUD within 14 days of the new SUD episode.

An intervention in this case is a psychosocial visit and can include any of the following:

• Substance use disorder treatment
• Psych visit psychotherapy
• Telephone visits (Encounter)
• Online Assessments (Encounter)

The medication can include either:

• Substance Use Disorder Short Acting Medication
• Substance Use Disorder Long Acting Medication

– NUMERATOR 2

Engagement in ongoing SUD treatment within 34 days of initiation includes:

• A long-acting SUD medication on the day after the initiation through 34 days after the initiation of treatment
• One of the following options on the day after the initiation of treatment through 34 days after the initiation of treatment: a) two engagement visits, b) two engagement medication treatment events, c) one engagement visit and one engagement medication treatment event.

 – DENOMINATOR EXCLUSIONS

Patients who are in hospice care for any part of the measurement period.

For Denominator:

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

• Documentation of the substance use disorder can be done via Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out the relevant details and click ‘Save’. Then click ‘Accept’ and the diagnosis is added to the provider note.

For Numerators 1&2:

• To record the Substance Use Disorder (SUD) diagnosis, navigate to Patient > Provider Notes > Diagnoses.
• The psychosocial interventions can be documented via the workflow Patient > Provider Notes > Evaluations or in the form of encounters through Patient > Provider Notes > Create Superbill.

• Both the Short Acting and Long Acting Medications can be prescribed through Patient > Provider Notes > Prescriptions. Click ‘Add’ and search for the relevant medicine. Enter the prescription details and click ‘Prescribe’.

• To document the procedure of administrating Short Acting and Long Acting Medication, head over to Patient > Provider Notes > Orders > Procedures. Click ‘Add’, search for the relevant procedure, fill out the details and click ‘Save & Accept’ or ‘Sign & Accept’.

Denominator Exclusions:

• 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.