CMS137v9 – 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 includes two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention (i.e., engagement for these members cannot be satisfied with medication treatment alone).

 – DENOMINATOR EXCLUSIONS

• Exclude patients with a previous active 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 whose hospice care overlaps the measurement period.

For Denominator:

Include patients 13 years and older with ‘First dependence diagnosis during measurement period’.

For ‘First dependence diagnosis during measurement period’, the patient should have qualifying encounter during the measurement period with a ‘Alcohol and drug dependence’ diagnosis. The diagnosis prevalence period should start during the encounter and 48 days or more before the day of end of measurement period.

• 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 ‘Dependence treatment intervention initiated’. For ‘Dependence treatment intervention initiated’ patient should have ‘Alcohol and drug dependence treatment’/’Psych Visit – Psychotherapy’ intervention or ‘Telehealth Services’ encounter performed 14 days or less after the day of start of ‘First dependence diagnosis during measurement period’. For ‘First dependence diagnosis during measurement period’ the patient should have ‘Alcohol and drug dependence’ diagnosis during a qualifying encounter. The diagnosis prevalence period should start 48 days or more before day of end of measurement period.
  • To document the ‘Telehealth Services’/qualifying encounter, use the workflow Patient > Provider Note > eSuperbill.
  • 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’ the patient should have ‘Opiate Antagonists’ medication ordered 14 days or less after the 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:

• Patients with two or more ‘Alcohol and drug dependence treatment’/’Psych Visit – Psychotherapy’ interventions or ‘Telehealth Services’ encounters performed 34 days or less after start of ‘Dependence treatment intervention initiated’.
  • To document the ‘Telehealth Services’ 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.
• Patients with ‘Opiate Antagonists’ ordered 34 days or less after start of ‘Dependence treatment intervention initiated’. To document the prescription, navigate to Patient > Provider Note > Prescription.
• Patients with two or more ‘Alcohol and drug dependence treatment’/’Psych Visit – Psychotherapy’ interventions or ‘Telehealth Services’ encounters performed 34 days or less after start of ‘Treatment initiation with medication order’.
  • To document the ‘Telehealth Services’ 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 document the prescription, navigate to Patient > Provider Note > Prescription.
• Patients with ‘Continuation of treatment event’ and ‘Opiates antagonists’ ordered during measurement period. The continued treatment should start 34 days or less after start of ‘Treatment initiation with medication order’. For ‘Continuation of treatment event’ the patient should have ‘Alcohol and drug dependence treatment’/’Psych Visit – Psychotherapy’ intervention or ‘Telehealth Services’ encounter performed with ‘Treatment initiation with medication order’.
  • To document the ‘Telehealth Services’ 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 document the prescription, navigate to Patient > Provider Note > Prescription.

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

• Patients with prior diagnosis of ‘Alcohol and drug dependence’ and ‘First dependence diagnosis during measurement period’. The prior dependence diagnosis prevalence period should start 60 days or less before the start of ‘First dependence diagnosis during measurement period’. 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.