[CQM-5510] CMS2v11 New coding for depression predating current visit Created: 08/16/22  Updated: 09/26/22  Resolved: 08/19/22

Status:

Closed

Project:

eCQM Issue Tracker

Component/s:

None

Type:

EC eCQMs

Priority:

Moderate

Reporter:

Tara Altman

Assignee:

Mathematica EC eCQM Team

Resolution:

Answered

Votes:

0

Labels:

None

Contact Name:

Tara Altman

Contact Email:

taltman@ncqa.org

Solution:

​​Thank you for your inquiry regarding CMS2v11: Preventive Care and Screening: Screening for Depression and Follow-Up Plan. Per the measure specification, only patients that have been diagnosed with depression or bipolar disorder, as defined within the codes of the "Bipolar Diagnosis" (2.16.840.1.113883.3.600.450) and "Depression Diagnosis" (2.16.840.1.113883.3.600.145) value sets, are captured as denominator exclusions.

Because the intent of the measure is to screen for depression in patients who have never had a diagnosis of depression or bipolar disorder prior to the eligible encounter, the measure logic specifically excludes patients who have a diagnosis of bipolar disorder or depression with an onset date that occurs before the qualifying encounter and remains an active diagnosis through or after the end of the qualifying encounter. See the "History of Bipolar or Depression Diagnosis Before Qualifying Encounter" denominator exclusion logic definition below.

History of Bipolar or Depression Diagnosis Before Qualifying Encounter
( ["Diagnosis": "Bipolar Diagnosis"]
  union ["Diagnosis": "Depression Diagnosis"] ) DiagnosisBipolarorDepression
  with "Qualifying Encounter During Measurement Period" QualifyingEncounter
    such that DiagnosisBipolarorDepression.prevalencePeriod starts before QualifyingEncounter.relevantPeriod

Solution Posted On:

2022 Performance Period EC eCQMs:

Impact:

Good morning,

Our project team received the inquiry below from an external partner regarding the following measure: Preventative Care and Screening: Screening for Depression and Follow-Up (CMS2v11). We would appreciate any insight your team is able to provide on this inquiry.

Last Commented Date:

Inquiry: This metric has an exclusion for prior depression or bipolar diagnosis. Is there any guidance for how to handle a patient whose first visit is addressing depression? There is no prior depression diagnosis on file for this patient, but it is known that the chief complaint for the initial visit is depression. Clinically, this patient may not be screened since the provider knows about the historic depression dx and plans to address it during the visit - even if it does not predate the visit. If a person’s primary complaint is “suicidality” (for example), we do not screen but may move directly to treatment. Right now those cases are numerator non compliant.

Are there any ways to exclude these cases or is it a limitation of the metric?

Comment by Tara Altman [ 09/26/22 ]

Good afternoon, 

I wanted to follow up in regards to my comment made on 8/22. Would that text still be applicable to add to the response for this inquiry?

Thank you!

Comment by Mathematica EC eCQM Team [ 08/24/22 ]

Thank you for the follow-up question. We will review your ticket and provide a response as soon as possible.

Comment by Tara Altman [ 08/22/22 ]

Hi there,

Would the following text be acceptable to add to the response for this inquiry?

"For the instances that you've described in your inquiry (initial visit is to address depression and/or suicidality), it would still be appropriate to screen these patients for depression using an age-appropriate standardized depression screening tool (e.g., to document and track their screening score at the initial visit for future reference)."

Thank you!

Comment by Mathematica EC eCQM Team [ 08/17/22 ]

Thank you for submitting your question. We will review your ticket and provide a response as soon as possible.