CMS 159v11: Depression Remission at Twelve Months

Measure: The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event
Measure Type High Priority Measure Scoring
Outcome Yes A higher percentage indicates better quality
Denominator Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event. Patients may be assessed using PHQ-9 or PHQ-9M on the same date or up to 7 days prior to the encounter (index event)
Numerator Adolescent patients 12 to 17 years of age and adult patients 18 years of age and older who achieved remission at twelve months as demonstrated by the most recent twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five
Denominator Exceptions None
Denominator Exclusions

  • Patients who died any time prior to the end of the measure assessment period

  • Patients who received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period

  • Patients who were permanent nursing home residents between the start of the denominator period and the end of the measurement assessment period

  • Patients with a diagnosis of bipolar disorder any time prior to the end of the measure assessment period

  • Patients with a diagnosis of personality disorder emotionally labile any time prior to the end of the measure assessment period

  • Patients with a diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period

  • Patients with a diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period

Patients who meet the following criteria will be included in the denominator:

  • Age is ≥ 12 years at the time of the initial PHQ-9 assessment

    AND

  • Have a PHQ-9 score > 9 on the day of the eligible encounter or in the 7 days prior to the encounter

    AND

  • Have at least one eligible encounter with an active diagnosis of major depression or dysthymia in the 14 to 2 months prior to the Measurement Period finalized by the EC

CPT: 90791, 90972, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 96156, 96158, 96159, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99421, 99422, 99423, 99441, 99442, 99443

HCPCS: G0402, G0438, G0439

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for major depression and dysthymia are:

Major Depression

ICD-10: F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.9 , F33.0, F33.1, F33.2 , F33.3, F33.40, F33.41 , F33.42, F33.9

Dysthymia

ICD-10: F34.1

To document a PHQ-9 assessment:

  1. Go to Encounter > Flowsheets/Labs > Standard or Chart > Flowsheets/Labs > Standard
  2. Click Add New Flowsheet
  3. Select the PHQ-9 flowsheet and click Add
  4. Click Add Column
  5. Select a Value for all questions in the PHQ-9
  6. Click OK to save

A patient will be excluded from the measure if they meet any of the following conditions:

  • Died any time prior to the end of the measure assessment period

  • Received hospice or palliative care services between the start of the denominator period and the end of the measurement assessment period

  • Was a permanent nursing home resident between the start of the denominator period and the end of the measurement assessment period

  • Had a diagnosis of bipolar disorder, personality disorder emotionally labile, schizophrenia or psychotic disorder, or pervasive developmental disorder any time prior to the end of the measure assessment period

To document a patient death:

  1. Go to Chart > Demographics > Patient Info

  2. Click Update

  3. Update patient Status to Deceased

  4. Populate the Date of Death field

  5. Click Save

To document hospice care ambulatory services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 99377, 99378

HCPCS: G0182

Order Status must be marked as Pending or Complete.

To document hospice care encounter services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

HCPCS: G9996, G9473, G9474, G9475, G9476, G9477, G9478, G9479, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5010, S9126, T2042, T2043, T2044, T2045, T2046

Order Status must be marked as Complete.

Palliative care services can be documented using the FACIT-Pal Questionnaire flowsheet, as an order, or as a diagnosis.

  1. Go to Encounter > Flowsheets/Labs > Standard or Chart > Flowsheets/Labs > Standard

  2. Click Add New Flowsheet

  3. Select the FACIT-Pal Questionnaire flowsheet and click Add

  4. Click Add Column

  5. Populate the patient's responses to the questions as appropriate

  6. Click OK to save

Go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

HCPCS: G9054, M1017

Order Status must be marked as Complete.

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis code for palliative care is:

ICD-10: Z51.5

To document nursing home stay using the Admissions tab:

  1. Go to Chart > Admissions and click Add

  2. Select Long Term Care as Place of Service

  3. Optional: select a Facility

  4. Populate the Admit Date

  5. Optional: populate the Discharge Date

    1. Note: if populated, the Discharge Date must be after the end of the measure assessment period to qualify as a patient exclusion

  6. Click OK

To document nursing home stay using the Orders tab, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

Order Status must be marked as Complete.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible bipolar disorder, personality disorder emotionally labile, schizophrenia or psychotic disorder, and pervasive developmental disorder codes can be located here.

A patient will be counted in the numerator if they achieved depression remission at twelve months as demonstrated by the most recent twelve month (+/- 60 days) PHQ-9 score less than five.

To document a PHQ-9 assessment:

  1. Go to Encounter > Flowsheets/Labs > Standard or Chart > Flowsheets/Labs > Standard
  2. Click Add New Flowsheet
  3. Select the PHQ-9 flowsheet and click Add
  4. Click Add Column
  5. Select a Value for all questions in the PHQ-9
  6. Click OK to save

https://ecqi.healthit.gov/ecqm/ec/2023/cms159v11

 

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