High Priority MeasureNo
SpecialtyMental/Behavioral Health Neurology
Percentage of patients with dementia for whom there was a documented symptoms screening* for behavioral and psychiatric symptoms, including depression, AND for whom, if symptoms screening was positive, there was also documentation of recommendations for symptoms management in the last 12 months.
This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of dementia seen during the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.
All patients with a diagnosis of dementia
Denominator Criteria (Eligible Cases):
All patients regardless of age
Diagnosis for dementia (ICD-10-CM): A52.17, A81.00, A81.01, A81.89, B20, F01.50, F01.51, F02, F02.80, F02.81, F03.90, F03.91, F05, F10.27, G20, G30.0, G30.1, G30.8, G30.9, G31.01, G31.09, G31.83, G31.85, G31.89, G94
Patient encounter during the performance period (CPT): 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 96116, 96118, 96119, 96120, 96127, 96150, 96151, 96152, 96154, 96155, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99487, 99489, 99490, 99497, 99498
Telehealth Modifier: GQ, GT, 95, POS 02
Patients with dementia for whom there was at least one documented symptoms screening* in the last 12 months for at least one symptom each for three domains of behavioral and psychiatric symptoms, including depression and for whom, if symptoms screening was positive, there was also documentation of recommendations for symptoms management in the last 12 months.
*Symptoms Screening for at least one symptom each for three domains of behavioral and psychiatric symptoms, including depression is defined as using a validated instrument or directly examining the patient or knowledgeable informant to determine the presence or absence of symptoms from three domains activity disturbances, mood disturbances (including depression), and thought and perceptional disturbances. The following is a non-exhaustive list of symptoms falling into each of the three requisite domains pertinent to this measure:
Activity disturbances (To meet measure, patient or knowledgeable informant must be screened for at least one symptom from this list):
- Purposeless hyperactivity
- Verbal or physical aggressiveness
- Resisting care
- Socially inappropriate behaviors
- Eating disturbances
- Sleep problems
- Diurnal/sleep-wake cycle disturbances
- Repetitive behavior
Mood disturbances (To meet measure, patient or knowledgeable informant must be screened for depression and at least one more symptom from this list)
- Mood lability/fluctuations
Thought and perceptual disturbances (To meet measure, patient or knowledgeable informant must be screened for at least one symptom from this list:
- Having fixed false beliefs (delusions)
- Hearing or seeing non-present entities (hallucinations)
Examples of reliable and valid instruments that are commonly used in research settings and that can be used to assess behavior include, but are not limited to:
Dementia Signs and Symptoms (DSS) Scale (1) or Neuropsychiatric Inventory (NPI) (2). The assessment of behavioral status may include the assessment of Behavioral and Psychological Symptoms of Dementia (BPSD) (3). For patients residing in nursing homes, it may include an assessment of the behavioral symptom items from the Minimum Data Set (MDS) (4)
Numerator Submission Criteria
Patients who were screened for behavioral and psychiatric symptoms for three domains at least once within the past 12 months
Positive Behavioral and Psychiatric Symptoms Screening includes documentation for at least one symptom for each of three domains: activity disturbances, mood disturbances, thought and perceptual disturbances including depression during an encounter
NUMERATOR NOTE: The 12 month look back period is defined as 12 months from the date of the denominator eligible encounter. In the event that a patient is not screened or partially screened during an eligible encounter for behavioral and psychiatric symptoms or the screening status is unknown submit G9921.
Performance Met: Screening Performed AND Positive AND Provision of Recommendations (G9919)
Performance Met: Screening Performed AND Negative (G9920)
Performance Not Met: No Screening Performed, Partial Screening Performed OR Positive Screen Without Recommendations and Reason is Not Given or Not Otherwise Specified (G9921)