CMS 2 Qualifying Encounters for PT and OT in an inpatient setting.

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Rhonda Smith
    • 336-403-9915
    • Novant Health
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      Thank you for your inquiry regarding CMS2v14 Preventive Care and Screening: Screening for Depression and Follow-Up Plan. A qualifying encounter for the measure does indeed include CPT codes for physical and occupational therapy services, as seen in the "Physical Therapy Evaluation" (2.16.840.1.113883.3.526.3.1022) and the "Encounter to Screen for Depression” (2.16.840.1.113883.3.600.1916) value sets. However, the measure’s encounter codes are not tied to a facility type (e.g., ambulatory, outpatient, inpatient hospital), so if one of the codes in the value set is documented, that meets the denominator criteria of a qualifying (eligible) encounter. If you could identify the location in the measure specification that “suggests that depression screening may not be appropriate in an inpatient setting” we would appreciate it so that clarifications can be made in a future version.
       
      These value sets are located on The National Library of Medicine's Value Set Authority Center (VSAC), https://vsac.nlm.nih.gov/ . The VSAC provides downloadable access to all official versions of value set content contained in the eCQM specifications.
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      Thank you for your inquiry regarding CMS2v14 Preventive Care and Screening: Screening for Depression and Follow-Up Plan. A qualifying encounter for the measure does indeed include CPT codes for physical and occupational therapy services, as seen in the "Physical Therapy Evaluation" (2.16.840.1.113883.3.526.3.1022) and the "Encounter to Screen for Depression” (2.16.840.1.113883.3.600.1916) value sets. However, the measure’s encounter codes are not tied to a facility type (e.g., ambulatory, outpatient, inpatient hospital), so if one of the codes in the value set is documented, that meets the denominator criteria of a qualifying (eligible) encounter. If you could identify the location in the measure specification that “suggests that depression screening may not be appropriate in an inpatient setting” we would appreciate it so that clarifications can be made in a future version.   These value sets are located on The National Library of Medicine's Value Set Authority Center (VSAC), https://vsac.nlm.nih.gov/ . The VSAC provides downloadable access to all official versions of value set content contained in the eCQM specifications.
    • CMS0002v14
    • Inflated denominator

      We currently offer Physical Therapy (PT) and Occupational Therapy (OT) services in the inpatient setting. Since PT and OT submit CPT codes for their evaluation services in this environment, these inpatients are being included in the denominator for Depression Screening. We are facing challenges in determining how to exclude them in our mapping, as our understanding of the measure suggests that depression screening may not be appropriate in an inpatient setting.

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Rhonda Smith (Inactive)
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              Created:
              Updated:
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