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 12 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 denominator identification 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 twelve months as demonstrated by a twelve 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 twelve months as demonstrated by a twelve 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 twelve months +/- 60 days after the index event date.
Index Event Date - The date on which the first instance of elevated PHQ-9 or PHQ-9M greater than nine 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) in length to allow for a follow-up PHQ-9 or PHQ-9M between 10 and 14 months following the index event. 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 6 Months measure (Quality ID #411). 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 denominator identification period or the measure assessment period
OR
Patients who were permanent nursing home residents any time during 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 twelve months as demonstrated by a twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five
Definitions:
Remission - a PHQ-9 or PHQ-9M score of less than five.
Twelve Months - The point in time from the index event date extending out twelve 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 twelve 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 twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5 (M1019)
OR
Performance Not Met: Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5. Either PHQ-9 or PHQ-9M score was not assessed or is greater than or equal to 5 (M1020)
Denominator (Submission Criteria 2)
Adult patients aged 18 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
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 twelve months +/- 60 days after the index event date.
Index Event Date - The date on which the first instance of elevated PHQ-9 or PHQ-9M greater than nine 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) in length to allow for a follow-up PHQ-9 or PHQ-9M between 10 and 14 months following the index event. 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 6 Months measure (Quality ID #411). 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 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 denominator identification period or the measure assessment period
OR
Patients who were permanent nursing home residents any time during denominator identification period or the measure assessment period
Numerator (Submission Criteria 2)
Adult patients aged 18 and older who achieved remission at twelve months as demonstrated by a twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five
Definitions:
Remission - a PHQ-9 or PHQ-9M score of less than five.
Twelve Months - The point in time from the index event date extending out twelve 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 twelve 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 twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5 (G9509)
OR
Performance Not Met: Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5. Either PHQ-9 or PHQ-9M score was not assessed or is greater than or equal to 5 (G9510)