#411: Depression Remission at Six Months

Quality ID

411

NQF

0711

High Priority Measure

Yes

Specifications

Registry

Measure Type

Outcome

Specialty

Mental/Behavioral Health

Measure Description

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 six months (+/- 60 days) after an index event date

 

Instructions

This measure is to be submitted once per performance period for patients with an encounter during the denominator identification period with a diagnosis of depression and an initial PHQ-9 or PHQ-9M greater than nine (index event). This measure may be submitted by Merit-based Incentive Payment System (MIPS) 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 a PHQ-9 or PHQ-9M score greater than 9 documented on the same date (index event) and this date occurs during the denominator identification measurement period (11/1/2017 to 10/31/2018).

This measure will be calculated with 2 performance rates:

1. Percentage of adolescent patients (aged 12-17 years) with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event who reached remission at six months as demonstrated by a six month (+/- 60 days) PHQ-9 or PHQ-9M score of less than 5.
2. Percentage of adult patients (aged 18 years or 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 who reached remission at six months as demonstrated by a six month (+/- 60 days) PHQ-9 or PHQ-9M score of less than 5.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

Denominator (Submission Criteria 1)

Adolescent patients 12 to 17 years of age with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event.

Definitions:

Denominator Identification Period - The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. The denominator identification period is from 11/1/2017 to 10/31/2018. For patients with an index event, there needs to be enough time following index for the patients to have the opportunity to reach remission six months +/- 60 days after the index event date.

Index Event Date - The date in which the first instance of elevated PHQ-9 or PHQ-9M greater than 9 AND diagnosis of depression or dysthymia occurs during the denominator identification period (11/1/2017 to 10/31/2018).

Measure Assessment Period - The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days). This 14 month measure assessment period allows for measurement of the patient’s remission status at both six and 12 months (Quality ID #370: Depression Remission at Twelve Months). This assessment period is fixed and does not “start over” with a higher PHQ-9 or PHQ-9M that may occur after the index event date.

Denominator Exclusions:

Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period – The following codes would be sufficient to define the Denominator Exclusion of bipolar disorder: F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89 or F31.9

For historical reference purposes these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of bipolar disorder: 296.00, 296.01, 296.02, 296.03, 296.04, 296.05, 296.06, 296.10, 296.11, 296.12, 296.13, 296.14, 296.15, 296.16, 296.40, 296.41, 296.42, 296.43, 296.44, 296.45, 296.46, 296.50, 296.51, 296.52, 296.53, 296.54, 296.55, 296.56, 296.60, 296.61, 296.62, 296.63, 296.64, 296.65, 296.66, 296.7, 296.80, 296.81, 296.82 or 296.89

Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period – The following codes would be sufficient to define the Denominator Exclusion of personality disorder: F34.0, F60.3, F60.4, F68.10, F68.11, F68.12 or F68.13

For historical reference purposes these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of personality disorder: 301.13, 301.5, 301.51 or 301.83

Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period – The following codes would be sufficient to define the Denominator Exclusion of schizophrenia or psychotic disorder: F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F23, F25.0, F25.1, F25.8, F25.9, F28 or F29

For historical reference purposes these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of schizophrenia or psychotic disorder: 295.00, 295.01, 295.02, 295.03, 295.04, 295.05, 295.10, 295.11, 295.12, 295.13, 295.14, 295.15, 295.20, 295.21, 295.22, 295.23, 295.24, 295.25, 295.30, 295.31, 295.32, 295.33, 295.34, 295.35, 295.40, 295.41, 295.42, 295.43, 295.44, 295.45, 295.50, 295.51, 295.52, 295.53, 295.54, 295.55, 295.60, 295.61, 295.62, 295.63, 295.64, 295.65, 295.70, 295.71, 295.72, 295.73, 295.74, 295.75, 295.80, 295.81, 295.82, 295.83, 295.84, 295.85, 295.90, 295.91, 295.92, 295.93, 295.94, 295.95, 298.0, 298.1, 298.4, 298.8 or 298.9

Patients with an active diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period – The following codes would be sufficient to define the Denominator Exclusion of pervasive developmental disorder: F84.0, F84.3, F84.8 or F84.9

For historical reference purposes these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of pervasive developmental disorder: 299.00, 299.01, 299.10, 299.11, 299.80, 299.81, 299.90 or 299.91

Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period – The following code would be sufficient to define the Denominator Exclusion of hospice or palliative care: Z51.5

DENOMINATOR NOTE: Data collection for this measure is structured to align with the Depression Remission at 12 Months measure (Quality ID #370). Data is captured on the same denominator patients and then measuring them at two distinct points in time, both at six months and at twelve months. The fourteen month assessment period is held constant for these two measures. This means that patient is not re-indexing with a high PHQ-9 or PHQ-9M until that measure assessment period is elapsed.

Denominator Criteria (Eligible Cases) 1:

Patients aged ≥ 12 years and ≤ 17 years

AND

Diagnosis for Major Depression or Dysthymia (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 denominator identification period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, G0402, G0438, G0439, 99441, 99442, 99443, 99444

AND

Index Event Date PHQ-9 or PHQ-9M Score greater than 9 documented during the twelve month denominator identification period: G9511

AND NOT

DENOMINATOR EXCLUSIONS:

Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period

OR

Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period

OR

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

OR

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

OR

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

OR

Patients who received hospice or palliative care service any time during the denominator identification period or the measure assessment period

OR

Patients who were permanent nursing home residents any time during the denominator identification period or the measure assessment period

 

Numerator (Submission Criteria 1)

Adolescent patients aged 12 to 17 years of age who achieved remission at six months as demonstrated by a six month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five

Definitions:

Remission - a PHQ-9 or PHQ-9M score less than five.

Six Months - The point in time from the index event date extending out six months then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four month period is deemed as remission at six months, values obtained prior to or after this period are not counted as numerator compliant (remission).

Numerator Options:

Performance Met: Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at six months as demonstrated by a six month (+/-60 days) PHQ-9 or PHQ-9M score of less than five (M1023)

OR

Performance Not Met: Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) PHQ-9 or PHQ-9M score of less than five. Either PHQ-9 or PHQ-9M score was not assessed or is greater than or equal to five (M1024)

 

Denominator (Submission Criteria 2)

Adult patients 18 years of age or 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.

Definitions:

Denominator Identification Period - The period in which eligible patients can have an index event. The denominator identification period occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. The denominator identification period is from 11/1/2017 to 10/31/2018. For patients with an index event, there needs to be enough time following index for the patients to have the opportunity to reach remission six months +/- 60 days after the index event date.

Index Event Date - The date in which the first instance of elevated PHQ-9 or PHQ-9M greater than 9 AND diagnosis of depression or dysthymia occurs during the denominator identification period (11/1/2017 to 10/31/2018).

Measure Assessment Period - The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days). This 14 month measure assessment period allows for measurement of the patient’s remission status at both six and 12 months (Quality ID #370: Depression Remission at Twelve Months). This assessment period is fixed and does not “start over” with a higher PHQ-9 or PHQ-9M that may occur after the index event date.

Denominator Exclusions:

Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period – The following codes would be sufficient to define the Denominator Exclusion of bipolar disorder: F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89 or F31.9

For historical reference purposes these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of bipolar disorder: 296.00, 296.01, 296.02, 296.03, 296.04, 296.05, 296.06, 296.10, 296.11, 296.12, 296.13, 296.14, 296.15, 296.16, 296.40, 296.41, 296.42, 296.43, 296.44, 296.45, 296.46, 296.50, 296.51, 296.52, 296.53, 296.54, 296.55, 296.56, 296.60, 296.61, 296.62, 296.63, 296.64, 296.65, 296.66, 296.7, 296.80, 296.81, 296.82 or 296.89

Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period – The following codes would be sufficient to define the Denominator Exclusion of personality disorder: F34.0, F60.3, F60.4, F68.10, F68.11, F68.12 or F68.13

For historical reference purposes these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of personality disorder: 301.13, 301.5, 301.51or 301.83

Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period – The following codes would be sufficient to define the Denominator Exclusion of schizophrenia or psychotic disorder: F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F23, F25.0, F25.1, F25.8, F25.9, F28 or F29

For historical reference purposes these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of schizophrenia or psychotic disorder: 295.00, 295.01, 295.02, 295.03, 295.04, 295.05, 295.10, 295.11, 295.12, 295.13, 295.14, 295.15, 295.20, 295.21, 295.22, 295.23, 295.24, 295.25, 295.30, 295.31, 295.32, 295.33, 295.34, 295.35, 295.40, 295.41, 295.42, 295.43, 295.44, 295.45, 295.50, 295.51, 295.52, 295.53, 295.54, 295.55, 295.60, 295.61, 295.62, 295.63, 295.64, 295.65, 295.70, 295.71, 295.72, 295.73, 295.74, 295.75, 295.80, 295.81, 295.82, 295.83, 295.84, 295.85, 295.90, 295.91, 295.92, 295.93, 295.94, 295.95, 298.0, 298.1, 298.4, 298.8 or 298.9

Patients with an active diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period – The following codes would be sufficient to define the Denominator Exclusion of pervasive developmental disorder: F84.0, F84.3, F84.8 or F84.9

For historical reference purposes these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of pervasive developmental disorder: 299.00, 299.01, 299.10, 299.11, 299.80, 299.81, 299.90 or 299.91

Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period – The following code would be sufficient to define the Denominator Exclusion of hospice or palliative care: Z51.5

DENOMINATOR NOTE: Data collection for this measure is structured to align with the Depression Remission at 12 Months measure (Quality ID #370). Data is captured on the same denominator patients and then measuring them at two distinct points in time, both at six months and at twelve months. The fourteen month assessment period is held constant for these two measures. This means that patient is not re-indexing with a high PHQ-9 or PHQ-9M until that measure assessment period is elapsed.

Denominator Criteria (Eligible Cases) 2:

Patients aged ≥ 18 years

AND

Diagnosis for Major Depression or Dysthymia (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 denominator identification period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, G0402, G0438, G0439, 99441, 99442, 99443, 99444

AND

Index Event Date PHQ-9 or PHQ-9M score greater than 9 documented during the twelve month denominator identification period: G9511

AND NOT

DENOMINATOR EXCLUSIONS:

Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period

OR

Patients with an active diagnosis of personality disorder any time prior to the end of the of the measure assessment period

OR

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

OR

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

OR

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

OR

Patients who received hospice or palliative care service any time during the denominator identification period or the measure assessment period

OR

Patients who were permanent nursing home residents any time during the denominator identification period or the measure assessment period

 

Numerator (Submission Criteria 2)

Adolescent patients aged 18 years of age or older who achieved remission at six months as demonstrated by a six month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five

Definitions:

Remission - a PHQ-9 or PHQ-9M score less than five.

Six Months - The point in time from the index event date extending out six months (+/- 60 days) then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four month period is deemed as remission at six months, values obtained prior to or after this period are not counted as numerator compliant (remission).

Numerator Options:

Performance Met: Adult patients 18 years of age or older with major depression or dysthymia who reached remission at six months as demonstrated by a six month (+/-60 days) PHQ-9 or PHQ-9M score of less than five (G9573)

OR

Performance Not Met: Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) PHQ-9 or PHQ-9M score of less than five. Either PHQ-9 or PHQ-9M score was not assessed or is greater than or equal to five (G9574)

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