High Priority MeasureNo
Percentage of all patients with a diagnosis of Parkinson’s Disease [PD] who were assessed for psychiatric symptoms once in the past 12 months
This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of Parkinson’s Disease seen during the performance period. 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: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.
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.
All patients with a diagnosis of Parkinson’s Disease
DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.
Denominator Criteria (Eligible Cases):
All patients regardless of age
Diagnosis for Parkinson’s disease (ICD-10-CM): G20
Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99241*, 99242*, 99243*, 99244*, 99245*, 99251*, 99252*, 99253*, 99254*, 99255*, 99304, 99305, 99306, 99307, 99308, 99309, 99310
Patients with a diagnosis of PD who were assessed for psychiatric symptoms once in the past 12 months
Assessed – Is a verbal discussion. Please see “Opportunity for Improvement” section below for suggestions on possible screening tools.
Psychiatric Symptoms – Defined as: psychosis (i.e., hallucinations and delusions), depression, anxiety disorder, apathy, AND Impulse Control Disorder (i.e., gambling, hypersexual activity, binge eating, increased spending).
Opportunity for Improvement
The following screening tools may be helpful for use in practice:
For depression (8):
Geriatric Depression scale
Hamilton Depression scale
For Anxiety (5):
Beck Anxiety Inventory
Hospital Anxiety and Depression Scale
Self-rating Anxiety Scale
Anxiety Status Inventory
Strait Trait Anxiety Inventory
Hamilton Anxiety Rating Scale
For Psychosis (4):
Parkinson psychosis rating scale
Rush hallucination inventory
Baylor hallucination questionnaire
Neuropsychiatric inventory (NPI or NPI-Q)
Brief psychiatric rating scale
Positive and negative syndrome scale
Schedule for assessment of positive symptoms
Unified Parkinson disease rating scale Part I
For Impulse Control Disorder (9):
Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale (QUIP-RS)
Minnesota Impulsive Disorders Interview
NUMERATOR NOTE: The 12 month look back period is defined as 12 months from the date of the denominator eligible encounter.
Performance Met: Psychosis, depression, anxiety, apathy, AND impulse control disorder assessed (G2121)
Performance Not Met: Psychosis, depression, anxiety, apathy, AND impulse control disorder not assessed (G2122)
Psychiatric symptoms are often under diagnosed and under treated. Using appropriate measures will assure that psychiatric symptoms are properly diagnosed and treated so as to not interfere with functioning levels.
Clinical Recommendation Statements
- Clinicians should be aware of dopamine dysregulation syndrome, an uncommon disorder in which dopaminergic medication misuse is associated with abnormal behaviors, including hypersexuality, pathological gambling and stereotypic motor acts. This syndrome may be difficult to manage. (Level D) (1)
- Clinicians should have a low threshold for diagnosing depression in PD. (Level D) (1)
- All people with PD and psychosis should receive a general medical evaluation and treatment for any precipitating condition. (Level D) (1)
- Patients should be warned about the potential for dopamine agonists to cause impulse control disorders and excessive daytime somnolence and be informed of the implications for driving/operating machinery. (Level A) (2)
- Self-rating or clinician-rated scales may be used to screen for depression in patients withParkinson’s Disease. (Level C) (2)