2016 PQRS Measure #411: Depression Remission at Six Months

DESCRIPTION

Adult patients age 18 years and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at six months defined as a PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment

INSTRUCTIONS

This measure is to be reported once per reporting period for patients seen during the denominator identification measurement period with a diagnosis of depression and an initial PHQ-9 greater than nine. This measure may be reported by 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 an index date PHQ-9 Score greater than 9 documented during the denominator identification measurement period dates of 12/1/2014 to 11/30/2015.

Measure Reporting via Registry:
ICD-10-CM diagnosis codes, CPT or HCPCS codes, patient demographics, and PHQ-9 scores are used to identify patients who are included in the measure’s denominator. The listed numerator options are used to report the numerator of the measure.

The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

DENOMINATOR

Adult patients age 18 years and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 score greater than nine

Definition:
Index Date - The first instance (12/1/2014 to 11/30/2015) of elevated PHQ-9 greater than 9 and diagnosis of depression or dysthymia

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years
AND
Diagnosis for MDD (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 reporting period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0402, G0438, G0439
AND
Index date PHQ-Score greater than 9 documented during the twelve month denominator identification period: G9572
AND NOT
Patients who died
OR
Patients who received hospice or palliative care service
OR
Patients who were permanent nursing home residents
OR
Patients with a diagnosis of bipolar disorder
OR
Patients with a diagnosis of personality disorder

NUMERATOR

Adults who achieved remission at six months as demonstrated by a six month (+/- 30 days) PHQ-9 score of less than five

Definitions:
Remission - a PHQ-9 score less than five.
Six Months - the point in time from the index date extending out six months (+/- 30 days). The most recent PHQ-9 score within six months +/- 30 days (5 to 7 months after index) that is less than five is deemed as remission at 6 months. Scores obtained prior to or after this period are not counted as numerator compliant (remission).

Numerator Options:
Performance Met: Remission at six months as demonstrated by a six month (+/-30 days) PHQ-9 score of less than five (G9573)
OR
Performance Not Met: Remission at six months not demonstrated by a six month (+/-30 days) PHQ-9 score of less than five. Either PHQ-9 score was not assessed or is greater than or equal to five. (G9574)
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Depression Remission at Six Months

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If reporting for Physician Quality Reporting System (PQRS) through another Centers for Medicare and Medicaid Services’ (CMS) program (such as the Medicare Shared Savings Program, Comprehensive Primary Care Initiative, Pioneer Accountable Care Organizations), please check the program’s requirements for information on how to report quality data to earn a PQRS incentive and/or avoid the PQRS payment adjustment.

Please note, although CMS has attempted to align or adopt similar reporting requirements across programs, eligible professionals (EPs) should look to the respective quality program to ensure they satisfy the PQRS, Electronic Health Record (EHR) Incentive Program, Value-based Payment Modifier (VM), etc. requirements of each of these programs.

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