Measure Description
The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had a follow-up visit with a mental health practitioner. Two rates are submitted:
• The percentage of discharges for which the patient received follow-up within 30 days after discharge.
• The percentage of discharges for which the patient received follow-up within 7 days after discharge.
Instructions
This measure is to be submitted at each follow-up visit occurring within 30 and 7 days after each inpatient setting discharge with a principal diagnosis of mental illness. 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: Discharged from an acute inpatient setting (including acute care psychiatric facilities) with a principal diagnosis of mental illness on or between January 1 and December 1 of the measurement period. The denominator for this measure is based on discharges, not on patients. If patients have more than one discharge, include all discharges on or between January 1 and December 1 of the measurement period.
If the discharge is followed by readmission or direct transfer to an acute facility for a principal diagnosis of mental health within the 30-day follow-up period, count only the readmission discharge or the discharge from the facility to which the patient was transferred.
This measure will be calculated with 2 performance rates:
1) The percentage of discharges for which the patient received follow-up within 30 days after discharge
2) The percentage of discharges for which the patient received follow-up within 7 days after discharge
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.
THERE ARE TWO SUBMISSION CRITERIA FOR THIS MEASURE:
1) The percentage of discharges for which the patient received follow-up within 30 days after discharge
AND
2) The percentage of discharges for which the patient received follow-up within 7 days after discharge
SUBMISSION CRITERIA 1: THE PERCENTAGE OF DISCHARGES FOR WHICH THE PATIENT RECEIVED FOLLOW-UP WITHIN 30 DAYS AFTER DISCHARGE
Denominator (Submission Criteria 1)
Patients 6 years of age and older who were discharged from an acute inpatient setting (including acute care psychiatric facilities) with a principal diagnosis of mental illness on or between January 1 and December 1 of the measurement period
Denominator Criteria (Eligible Cases) 1:
Patients aged 6 years and older as of the date of discharge
AND
Diagnosis for mental illness (ICD-10-CM): F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, 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, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.81, F32.89, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.81, 34.89, F34.9, F39, F42.2, F42.3, F42.4, F42.8, 42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.8, F43.9, F44.89, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F68.10, F68.11, F68.12, F68.13, F68.8, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0, F91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9
AND
Patient encounter during the performance period (CPT): 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99291
AND
Patient alive at time of acute inpatient setting discharge
AND
Patient is discharged from an acute inpatient setting on or between January 1 and December 1 of the measurement period
AND
Exclude discharges followed by readmission or direct transfer to a non-acute facility within the 30- day follow-up period, regardless of principal diagnosis for the readmission.
AND
Exclude discharges followed by readmission or direct transfer to an acute facility within the 30-day follow-up period if the principal diagnosis was for non-mental health
AND NOT
DENOMINATOR EXCLUSION:
Patients who use hospice services any time during the measurement period: G9760
NOTE: These discharges are excluded from the measure because readmission or transfer may prevent an outpatient follow-up visit from taking place.
Numerator (Submission Criteria 1): Patient Received Follow-Up within 30 Days after Discharge
A follow-up visit with a mental health practitioner within 30 days after acute inpatient discharge. Do not include visits that occur on the date of discharge.
Numerator Options:
Performance Met: Patient received follow-up on the date of discharge or within 30 days after discharge (G9402)
OR
Denominator Exception Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up) (G9403)
OR
Performance Not Met: Patient did not receive follow-up within 30 days after discharge (G9404)
SUBMISSION CRITERIA 2: THE PERCENTAGE OF DISCHARGES FOR WHICH THE PATIENT RECEIVED FOLLOW-UP WITHIN 7 DAYS AFTER DISCHARGE
Denominator (Submission Criteria 2)
Patients 6 years of age and older who were discharged from an acute inpatient setting (including acute care psychiatric facilities) with a principal diagnosis of mental illness on or between January 1 and December 1 of the measurement period
Denominator Criteria (Eligible Cases) 2:
Patients aged 6 years and older as of the date of discharge
AND
Diagnosis for mental illness (ICD-10-CM): F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, 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, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.81, F32.89, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.81, F34.89, F34.9, F39, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.8, F43.9, F44.89, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F68.10, F68.11, F68.12, F68.13, F68.8, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0, F91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9
AND
Patient encounter during the performance period (CPT): 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99291
AND
Patient alive at time of acute inpatient setting discharge
AND
Patient is discharged from an acute inpatient setting on or between January 1 and December 1 of the measurement period
AND
Exclude discharges followed by readmission or direct transfer to a non-acute facility within the 30- day follow-up period, regardless of principal diagnosis for the readmission
AND
Exclude discharges followed by readmission or direct transfer to an acute facility within the 30-day follow-up period if the principal diagnosis was for non-mental health
AND NOT
DENOMINATOR EXCLUSION:
Patients who use hospice services any time during the measurement period: G9760
NOTE: These discharges are excluded from the measure because readmission or transfer may prevent an outpatient follow-up visit from taking place.
Numerator (Submission Criteria 2): Patient Received Follow-Up within 7 Days after Discharge
A follow-up visit with a mental health practitioner within 7 days after acute inpatient discharge. Do not include visits that occur on the date of discharge
Numerator Options:
Performance Met: Patient received follow-up within 7 days after discharge (G9405)
OR
Denominator Exception: Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e., patient death prior to follow-up visit, patient non-compliance for visit follow-up) (G9406)
OR
Performance Not Met: Patient did not receive follow-up within 7 days after discharge (G9407)