CMS2-Depression Screening and Follow Up

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
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      Thank you for providing additional details for our review. The measure is not intended to include inpatient services; however, Emergency Services are not excluded from the measure.
      o Scenarios 1 and 2: CPT codes 97150 and 97162 are not included in the "Encounter to Screen for Depression" value set. Perhaps your vendor is mapping these to a code within the value set? Your organization may need to engage your EHR vendor/data submitter to investigate this further.

      o Scenario 3: CPT code 99215 includes the following description: "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.” Therefore, using that CPT code may not be accurate for an inpatient consultation. Assuming this is a health system EHR, you may need to engage the hospital's coding department to investigate this further.
      Show
      Thank you for providing additional details for our review. The measure is not intended to include inpatient services; however, Emergency Services are not excluded from the measure. o Scenarios 1 and 2: CPT codes 97150 and 97162 are not included in the "Encounter to Screen for Depression" value set. Perhaps your vendor is mapping these to a code within the value set? Your organization may need to engage your EHR vendor/data submitter to investigate this further. o Scenario 3: CPT code 99215 includes the following description: "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.” Therefore, using that CPT code may not be accurate for an inpatient consultation. Assuming this is a health system EHR, you may need to engage the hospital's coding department to investigate this further.
    • CMS0002v14

      We have observed many instances of the following scenario:

      Patient has a visit to the Emergency Department or has an Inpatient hospital stay.  The ED visit or hospital stay itself is not billed with an eligible visit code(s).  However, a specialty consult is ordered while the patient is in the ED or inpatient setting which is billed with an eligible visit code.  These 'consult' visits are pulling the putting the patient into the initial measure population (patient does not have any other eligible visit during the measurement period). 

      Is the intent of the measure to include patients in the population who are being seen for emergency, urgent, or acute inpatient care?

      Thank you in advance for your guidance.

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Shari Black
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              Created:
              Updated:
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