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  2. CQM-5602

CRP: Harmonize Bipolar Disorder exclusion coding with other eCQMs

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    • Other
    • Resolution: Unresolved
    • Moderate
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      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 or up to two days after the date of the qualifying encounter

      Description of issue:
      This measure currently uses the value set Bipolar Diagnosis ​(OID: 2.16.840.1.113883.3.600.450) within the denominator exclusions. The Value Set Workgroup noted that the Bipolar Diagnosis value set is very similar to the Bipolar Disorder value set (OID: 2.16.840.1.113883.3.67.1.101.1.128). However, the current value set contains a few ICD-9-CM codes, doesn't include codes associated with Manic Affective Disorder, and other smaller differences. The VSW recommended using the Bipolar Disorder value set to allow for harmonization. 

      Based on the literature, the measure developer recommends that the full spectrum of the disorder continue to be the focus of the exclusion. This was discussed with the expert work group in July 2022 who agreed that it is clinically appropriate to continue excluding all patients with bipolar disorder, rather than excluding a subset of patients with bipolar disorder with depressive features.

      Goal of review:
      Obtain clinical feedback
      Show
      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 or up to two days after the date of the qualifying encounter Description of issue: This measure currently uses the value set Bipolar Diagnosis ​(OID: 2.16.840.1.113883.3.600.450) within the denominator exclusions. The Value Set Workgroup noted that the Bipolar Diagnosis value set is very similar to the Bipolar Disorder value set (OID: 2.16.840.1.113883.3.67.1.101.1.128). However, the current value set contains a few ICD-9-CM codes, doesn't include codes associated with Manic Affective Disorder, and other smaller differences. The VSW recommended using the Bipolar Disorder value set to allow for harmonization.  Based on the literature, the measure developer recommends that the full spectrum of the disorder continue to be the focus of the exclusion. This was discussed with the expert work group in July 2022 who agreed that it is clinically appropriate to continue excluding all patients with bipolar disorder, rather than excluding a subset of patients with bipolar disorder with depressive features. Goal of review: Obtain clinical feedback
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      Proposed solution:
      ​Replace the Bipolar Diagnosis (2.16.840.1.113883.3.600.450) value set used in the measure with the Bipolar Disorder (2.16.840.1.113883.3.67.1.101.1.128) value set.

      CURRENT LOGIC:
      define "History of Bipolar or Depression Diagnosis Before Qualifying Encounter"
      ( ["Diagnosis": "Bipolar Diagnosis"]
      [...]
          such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod

      PROPOSED LOGIC:
      define "History of Bipolar or Depression Diagnosis Before Qualifying Encounter"
      ( ["Diagnosis": "Bipolar Disorder"]
      [...]
          such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod

      Rationale for change:
      ​This change aligns with the measure intent to exclude all patients with bipolar disorder and also allows for harmonization with other measures.
      Show
      Proposed solution: ​Replace the Bipolar Diagnosis (2.16.840.1.113883.3.600.450) value set used in the measure with the Bipolar Disorder (2.16.840.1.113883.3.67.1.101.1.128) value set. CURRENT LOGIC: define "History of Bipolar or Depression Diagnosis Before Qualifying Encounter" ( ["Diagnosis": "Bipolar Diagnosis"] [...]     such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod PROPOSED LOGIC: define "History of Bipolar or Depression Diagnosis Before Qualifying Encounter" ( ["Diagnosis": "Bipolar Disorder"] [...]     such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod Rationale for change: ​This change aligns with the measure intent to exclude all patients with bipolar disorder and also allows for harmonization with other measures.

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          edave Mathematica EC eCQM Team
          edave Mathematica EC eCQM Team
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