Measure: Percentage of patients 13 years of age and older with a new substance use disorder (SUD) episode who received the following (Two rates are reported):
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| Measure Type | High Priority Measure | Scoring |
| Process | No | A higher percentage indicates better quality |
| Denominator | Patients 13 years of age and older as of the start of the measurement period who were diagnosed with a new SUD episode during a visit between January 1 and November 14 of the measurement period |
| Numerator | Numerator 1: Initiation of treatment includes either an intervention or medication for the treatment of SUD within 14 days of the new SUD episode. Numerator 2: Engagement in ongoing SUD treatment within 34 days of initiation includes:
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| Denominator Exceptions | None |
| Denominator Exclusions | Exclude patients who are in hospice care for any part of the measurement period |
Denominator
Patients who meet the following criteria will be included in the denominator:
Age is 13 years or older at the start of the measurement period
AND have a diagnosis of a new SUD episode during a visit between January 1 and November 14 of the Measurement Period
AND have no history of SUD diagnosis or treatment
Encounter Codes Eligible for Denominator
CPT: 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 99221, 99222, 99223, 99234, 99235, 99236, 99238, 99239, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98966, 98967, 98968, 99441, 99442, 99443, Â 98970, 98971, 98972, 98980, 98981, 99421, 99422, 99423, 99457, 99458
HCPCS: G0071, G2010, G2012, G2250, G2251, G2252
Diagnosis
Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for substance use disorders can be located here.
History of SUD Diagnosis or Treatment
A patient will not be included in the denominator if they have had a SUD 60 days prior to their first SUD during the Measurement Period.
Denominator Exclusions
Patients who have an order for or are receiving hospice care during the Measurement Period will be excluded from this measure.
Hospice Care Services
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: 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.
Numerator
Numerator 1
A patient will be counted in numerator 1 if the patient receives either an intervention or medication for the treatment of SUD within 14 days of the new SUD episode.
Intervention
To document an intervention, the following codes are eligible:
CPT: 90832, 90834, 90837, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98966, 98967, 98968, 99441, 99442, 99443, 98970, 98971, 98972, 98980, 98981, 99421, 99422, 99423, 99457, 99458
HCPCS: G2067, G2068, G2069, G2070, G2071, G2072, G2073, G2074, G2075, G2076, G2077, G2080, G2086, G2087, H0020, H0033, G0071, G2010, G2012, G2250, G2251, G2252
Medication
To prescribe a medication for substance use disorder, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription or Chart > Medications/Assessments > Modify. A comprehensive list of eligible medications can be located here.
Numerator 2
A patient will be counted in numerator 2 if one of the following are met within 34 days of the new SUD episode:
Has treatment engagement with long acting medication
Has two or more treatment engagements with short acting medications or non medication interventions
Medication
To prescribe a medication for substance use disorder, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription or Chart > Medications/Assessments > Modify. A comprehensive list of eligible medications can be located here.
Intervention
To document an intervention, the following codes are eligible:
CPT: 90832, 90834, 90837, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98966, 98967, 98968, 99441, 99442, 99443, 98970, 98971, 98972, 98980, 98981, 99421, 99422, 99423, 99457, 99458
HCPCS: G2067, G2068, G2069, G2070, G2071, G2072, G2073, G2074, G2075, G2076, G2077, G2080, G2086, G2087, H0020, H0033, G0071, G2010, G2012, G2250, G2251, G2252
eCQI Reference
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