Good afternoon,

Program: QPP-Traditional MIPS

I am reaching out to seek clarification on CMS2v12 Preventative Care and Screening for Depression and Follow up Plan. In particular how and by whom the documentation of the score of the result of the depression screen. In the measure spec it references that for data capture the score is not needed and the depression screening must be reviewed and addressed by the provider.

Our workflow is typically the medical assistant rooms the patient and screens the patient using Depression Screening tool PHQ 2/9. The replies to these responses have a score that correlates to the response. The MA documents the answers and calculates the total. If the answers to the first 2 questions are 3 or less this is considered negative and not need to move on to a PHQ9. If >3 the MA would administer the full 9 questions and total this score. This would be considered positive and would require a medical staff assessment and next steps and they document as such. If the score is zero meaning the first 2 or all 9 reveals a zero, does the medical staff still have to be the one to document to say it was negative, even though it's clear a score of zero is negative. Can the MA or RN document that its negative?