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  1. eCQM Issue Tracker
  2. CQM-4861

Include manic episode related coding for denominator exclusion of Bipolar Disorder



    • EP/EC eCQMs
    • Status: Open
    • Moderate
    • Resolution: Unresolved
    • None


      Brief Description of Measure: 

      CMS2: Preventive Care and Screening: Screening for Depression and Follow-Up Plan
      Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter

      Description of Issue: 

      ​The intent of the measure is to screen for depression in patients who have never had a diagnosis of depression or bipolar disorder prior to the qualifying encounter used to evaluate the measure numerator. Patients who have ever been diagnosed with depression or bipolar disorder will be excluded from the measure, meaning they will be removed from the measure denominator.
      A stakeholder noted that the Bipolar Diagnosis value set (2.16.840.1.113883.3.600.450) contains the ICD-9-CM code 296.01 “Bipolar I disorder, single manic episode, mild” but does not include the ICD-10-CM equivalent F30.11 “Manic episode without psychotic symptoms, mild.” The stakeholder inquired if the ICD-10-CM code could be considered for addition to the Bipolar Diagnosis value set. 
      This issue was reviewed with the expert work group (EWG) in August 2021. The EWG members stated that the ICD-10-CM codes in the F30.xx series (including F30.11 “Manic episode without psychotic symptoms, mild”) should be added to the Bipolar Diagnosis value set, explaining that manic episodes are typically included in the bipolar disorder spectrum and therefore should be excluded from the measure denominator, per the measure intent. ** 

      Proposed Solution:

      Add the following ICD-10-CM codes in the F30.xx series to the Bipolar Diagnosis value set (2.16.840.1.113883.3.600.450):
      F30.2, Manic episode, severe with psychotic symptoms
      F30.3, Manic episode in partial remission           
      F30.4, Manic episode in full remission                              
      F30.8, Other manic episodes                                         
      F30.9, Manic episode, unspecified
      F30.10, Manic episode without psychotic symptoms, unspecified
      F30.11, Manic episode without psychotic symptoms, mild
      F30.12, Manic episode without psychotic symptoms, moderate
      F30.13, Manic episode, severe, without psychotic symptoms 

      Rationale for Change:

      Adding these codes will ensure that the Bipolar Diagnosis value set (2.16.840.1.113883.3.600.450) includes appropriate codes and that the proper patients are captured for the denominator exclusion. ** 





            khancock Mathematica EC eCQM Team
            sgearhart Mathematica EH eCQM Team
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