| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| EHR, CMS Web Interface, Registry | Outcome | Yes | Effective Clinical Care | Mental/Behavioral Health, General Practice/Family Medicine |
Measure Description
Patients age 18 and older with major depression or dysthymia and an initial Patient Health Questionnaire (PHQ-9) score greater than nine who demonstrate remission at twelve months (+/- 30 days after an index visit) defined as a PHQ-9 score less than five. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.
Instruction
This measure is to be reported once per performance period for patients seen during the denominator identification measurement period with a diagnosis of depression and an initial PHQ-9 greater than nine. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
NOTE: To be considered denominator eligible for this measure, the patient must have both the diagnosis of depression or dysthymia and an index date PHQ-9 Score greater than 9 documented during the dates of denominator identification measurement period (12/1/2015 to 11/30/2016). Encounters in a Psychiatric, Behavioral, or Mental Health Setting require the diagnosis of depression or dysthymia to be a primary diagnosis.
Denominator
Patients age 18 and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 score greater than nine during the index visit
Definition:
Index Date – The first instance (12/1/2015 to 11/30/2016) of elevated PHQ-9 greater than 9 and diagnosis of depression or dysthymia
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years
AND
Diagnosis for MDD (ICD-10-CM): 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, F34.1
AND
Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0402, G0438, G0439
AND
Index Date PHQ-9 Score greater than 9 documented during the twelve month denominator identification period: G9511
AND NOT
DENOMINATOR EXCLUSIONS:
Patients who died
OR
Patients who received hospice or palliative care service
OR
Patients who were permanent nursing home residents
OR
Patients with a diagnosis of bipolar disorder
OR
Patients with a diagnosis of personality disorder
Numerator
Patients who achieved remission at twelve months as demonstrated by a twelve month (+/- 30 days grace period) PHQ-9 score of less than five
Definitions:
Remission – a PHQ-9 score of less than five.
Twelve Months – the point in time from the index date extending out twelve months (+/- 30 days). The most recent PHQ-9 score less than five obtained during this two month period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission).
Numerator Options:
Performance Met: Remission at twelve months as demonstrated by a twelve month (+/-30 days) PHQ-9 score of less than 5 (G9509)
OR
Performance Not Met: Remission at twelve months not demonstrated by a twelve month (+/-30 days) PHQ-9 score of less than five. Either PHQ-9 score was not assessed or is greater than or equal to 5 (G9510)