This is a follow-up question in relation to CQM-6541, which stated that, you can use SNOMED CT 91310009 (Patient follow-up to return when and if necessary (procedure). as a follow Up for Adolescent Depression (2.16.840.1.113883.3.526.3.1569) and Follow Up for Adult Depression (2.16.840.1.113883.3.526.3.1568) value sets. However, self- referral to the same primary care physician (PCP) that completed the positive depression screen without documenting a of an additional follow-up plan to address the positive screen does not meet numerator criteria. Documented follow-up plans for a positive depression screening must include one or more of the following:

• Referral to a provider for additional evaluation and assessment to formulate a follow-up plan for a positive depression screen - "Intervention, Order": "Referral for Adult Depression" OR "Intervention, Order": "Referral for Adolescent Depression"

• Pharmacological interventions - "Medication, Order": "Adult Depression Medications" OR "Medication, Order": "Adolescent Depression Medications"

• Other interventions or follow-up for the diagnosis or treatment of depression, such as, but not limited to behavioral health evaluation, psychotherapy, family or group therapy, support group, depression management program - "Intervention, Performed": "Follow Up for Adult Depression" OR "Intervention, Performed": "Follow Up for Adolescent Depression"

You will need to document one of follow-up plan interventions above in the medical record when using use SNOMED CT 91310009 (Patient follow-up to return when and if necessary (procedure), to meet the numerator. I have the following questions:

1. When using CT 91310009 (Patient follow-up to return when and if necessary (procedure)? “Return” where would be appropriate for the patient to return to satisfy the numerator criteria? My understanding of the word “return” is that it means to come back to a location where one once was (i.e, the PCP’s office)
2. Re: “if necessary” – it seems to me something like the following statement would suffice: “The patient will be referred to a behavioral health provider at the next visit if needed” would suffice.
3. Would the numerator criteria for the measure be met by referral to a social worker for further triage and referral to a behavioral health provider?
4. What is the guidance for complaint documentation when the PCPs plans on following up with the patient to provide further assessment or treatment provided by the PCP?
5. What are examples of “other service for treatment of depression”? Further management by the PCP is certainly another service for the treatment of depression.