Measure Description
Percentage of all patients with a diagnosis of Parkinson’s Disease [PD] who were assessed for depression, anxiety, apathy, AND psychosis once during the measurement period.
Instructions
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.
Denominator
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
AND
Diagnosis for Parkinson’s disease (ICD-10-CM): G20
AND
Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99421, 99422, 99423, 99441, 99442, 99443, 99483
Numerator
Patients who were assessed for depression, anxiety, apathy, AND psychosis once during the measurement period
Definitions:
Assessed – use of a screening tool or discussion with the patient or care partner. Please see “Opportunity for Improvement” section below for suggestions on possible screening tools.
Psychosis – includes hallucinations, illusions, delusions, paranoia.
Numerator Instructions:
Opportunity for Improvement
The following screening tools may be helpful for use in practice:
For depression:
Geriatric Depression scale Beck Depression
Hamilton Depression scale
Patient Health Questionnaire 2 (PHQ2)
Patient Health Questionnaire 9 (PHQ9)
Montgomery-Asberg Depression Rating Scale (MADRS)
For Anxiety:
Beck Anxiety Inventory
Hospital Anxiety and Depression Scale Self-rating Anxiety Scale
Anxiety Status Inventory
Strait Trait Anxiety Inventory
Hamilton Anxiety Rating Scale
Parkinson Anxiety Scale (PAS)
For Psychosis:
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
Numerator Options:
Performance Met: Depression, anxiety, apathy, AND psychosis assessed (G2121)
OR
Performance Not Met: Depression, anxiety, apathy, AND psychosis not assessed (G2122)
Rationale
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 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)
- Self-rating or clinician-rated scales may be used to screen for depression in patients with Parkinson’s Disease. (Level C) (2)
- At review appointments and following medicines changes, ask people with Parkinson’s disease and their family members and carers (as appropriate) if the person is experiencing hallucinations (particularly visual) or delusions.
- Perform a general medical evaluation for people with hallucations or delusions, and offer treatment for any conditions that might have triggered them.
- Be alert to possible depression (particularly in patients with a past history of depression or a chronic physical health problem with associated functional impairment) and consider asking patients who may have depression two questions, specifically:
- During the last month, have you often been bothered by feeling down, depressed or hopeless?
- During the last month, have you often been bothered by having little interest or pleasure in doing things?
- When assessing a patient with suspected depression, consider using a validated measure (for example, for symptoms, functions and/or disability) to inform and evaluate treatment.