CMS 2 - Screening for Depression and F/U Care: Non-MIPS eligible providers.

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
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      Thank you for inquiring about version 14 of the Preventive Care and Screening: Screening for Depression and Follow-Up Plan eCQM. Below are responses to your scenarios:
      • Scenario 1: Documentation of planned follow-up with a PCP or other provider to assess or address the patient needs related to the positive screen would not suffice for the measure unless there was a documented referral order (i.e., "Referral to primary care service” SNOMED-CT code 703978000 or another eligible provider in the Referral for Adult Depression value set available here: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1571/expansion/eCQM%20Update%202024-05-02).
      • Scenario 2: Sidebar conversations cannot be used for compliance in the measure. However, if the patient is already being treated for depression and there are no changes to the treatment plan, you may document SNOMED CT 410234004 (Management of mental health treatment (procedure)) or SNOMED CT 410232000 (Mental health treatment assessment (procedure)) and note that you advised the patient to continue with their current depression plan of care. Please refer to known issue EKI-22.
      • Scenario 3: The patient refusal exception only applies when the “Patient refuses to participate in or complete the depression screening.” In your scenario, if the provider orders an intervention (e.g., a medication to treat the patient’s depression or a referral for psychotherapy), then the provider’s intended numerator action is considered completed regardless of whether the patient fills the prescription or sees the psychotherapist. The patient's active participation is not required for the numerator if the order was placed.
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      Thank you for inquiring about version 14 of the Preventive Care and Screening: Screening for Depression and Follow-Up Plan eCQM. Below are responses to your scenarios: • Scenario 1: Documentation of planned follow-up with a PCP or other provider to assess or address the patient needs related to the positive screen would not suffice for the measure unless there was a documented referral order (i.e., "Referral to primary care service” SNOMED-CT code 703978000 or another eligible provider in the Referral for Adult Depression value set available here: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1571/expansion/eCQM%20Update%202024-05-02) . • Scenario 2: Sidebar conversations cannot be used for compliance in the measure. However, if the patient is already being treated for depression and there are no changes to the treatment plan, you may document SNOMED CT 410234004 (Management of mental health treatment (procedure)) or SNOMED CT 410232000 (Mental health treatment assessment (procedure)) and note that you advised the patient to continue with their current depression plan of care. Please refer to known issue EKI-22 . • Scenario 3: The patient refusal exception only applies when the “Patient refuses to participate in or complete the depression screening.” In your scenario, if the provider orders an intervention (e.g., a medication to treat the patient’s depression or a referral for psychotherapy), then the provider’s intended numerator action is considered completed regardless of whether the patient fills the prescription or sees the psychotherapist. The patient's active participation is not required for the numerator if the order was placed.
    • CMS0002v14

      Our organization has instances in which Medicare Annual Wellness Visits (AWV) are being performed by an RN or a pharmacist.  These visits are being billed with an eligible encounter code under the patient's primary care provider.  Medicare requires that these visits include a depression screening which is occurring.  Our questions related to documentation of the follow-up plan when a patient has a positive depression screen.

      Scenario 1: RN/Pharmacist/Other non-prescribing care team member documents that the patient was scheduled for an office visit with the patient's PCP or another MIPS eligible provider at a later date to assess and address patient needs related to the positive screen.

      Scenario 2: RN/Pharmacist/Other non-prescribing care team member has sidebar conversation with the patient's primary care provider or other MIPS eligible provider to 'continue current treatment plan' (medication, psychotherapy, etc.)

      Scenario 3: RN/Pharmacist has conversation with patient who then declines additional intervention/care regarding positive screen.

      Would these scenarios meet numerator criteria as a follow-up plan for patients who screen positive for depression?

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Shari Black
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