2016 PQRS Measure #391: Follow-Up After Hospitalization for Mental Illness (FUH)

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 an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported:
 The percentage of discharges for which the patient received follow-up within 30 days of discharge.
 The percentage of discharges for which the patient received follow-up within 7 days of discharge.

INSTRUCTIONS

This measure is to be reported at each outpatient visit, intensive outpatient visit, or partial hospitalization occurring within 30 and 7 days of each inpatient setting discharge with a principal diagnosis of mental illness. 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: 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.

Use only discharges from the facility to identify denominator events (including readmissions or direct transfers). Do not use professional claims.

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 of discharge

AND
2) The percentage of discharges for which the patient received follow-up within 7 days of discharge

DENOMINATOR (REPORTING 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-9-CM) [for use 1/1/2014-9/30/2014]:, 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, 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, 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.26, 296.30, 296.31, 296.32, 296.33, 296.34, 296.35, 296.36, 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, 296.89, 296.90, 296.99, 297.0, 297.1, 297.2, 297.3, 297.8, 297.9, 298.0, 298.1, 298.2, 298.3, 298.4, 298.8, 298.9, 299.00, 299.01, 299.10, 299.11, 299.80, 299.81, 299.90, 299.91, 300.3, 300.4, 301.0, 301.10, 301.11, 301.12, 301.13, 301.20, 301.21, 301.22, 301.3, 301.4, 301.50, 301.51, 301.59, 301.6, 301.7, 301.81, 301.82, 301.83, 301.84, 301.89, 301.9, 308.0, 308.1, 308.2, 308.3, 308.4, 308.9, 309.0, 309.1, 309.21, 309.22, 309.23, 309.24, 309.28, 309.29, 309.3, 309.4, 309.81, 309.82, 309.83, 309.89,309.9, 311, 312.00, 312.01, 312.02, 312.03, 312.10, 312.11, 312.12, 312.13, 312.20, 312.21, 312.22, 312.23, 312.30, 312.31, 312.32, 312.33, 312.34, 312.35, 312.39, 312.4, 312.81, 312.82, 312.89, 312.9, 313.0, 313.1, 313.21, 313.22, 313.23, 313.3, 313.81, 313.82, 313.83, 313.89, 313.9, 314.00, 314.01, 314.1, 314.2, 314.8, 314.9, 648.44.
Diagnosis for mental illness (ICD-10-CM) [for use 10/01/2014-12/31/2014 REFERENCE ONLY/Not Reportable: 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, F32.8, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.8, F34.9, F39, F42, 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, F53, 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 reporting period (CPT or HCPCS): 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 nonacute facility within the 30-day followup period, regardless of principal diagnosis for the readmission. 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.

NOTE: These discharges are excluded from the measure because readmission or transfer may prevent an outpatient follow-up visit from taking place.


OR


DENOMINATOR (REPORTING 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-9-CM) [for use 1/1/2014-9/30/2014]: 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, 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, 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.26, 296.30, 296.31, 296.32, 296.33, 296.34, 296.35, 296.36, 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, 296.89, 296.90, 296.99, 297.0, 297.1, 297.2, 297.3, 297.8, 297.9298.0, 298.1, 298.2, 298.3, 298.4, 298.8, 298.9, 299.00, 299.01, 299.10, 299.11, 299.80, 299.81, 299.9, 299.90, 299.91, 300.3, 300.4, 301.0, 301.10, 301.11, 301.12, 301.13, 301.20, 301.21, 301.22, 301.3, 301.4, 301.50, 301.51, 301.59, 301.6, 301.7, 301.81, 301.82, 301.83, 301.84, 301.89, 301.9, 308.0, 308.1, 308.2, 308.3, 308.4, 308.9, 309.0, 309.1, 309.21, 309.22, 309.23,309.24, 309.28, 309.29, 309.3, 309.4, 309.81, 309.82, 309.83, 309.89,309.9, 311, 312.0, 312.00, 312.01, 312.02, 312.03, 312.10, 312.11, 312.12, 312.13, 312.20, 312.21, 312.22, 312.23, 312.30, 312.31, 312.32, 312.33, 312.34, 312.35, 312.39, 312.4, 312.81, 312.82, 312.89, 312.9, 313.0, 313.1, 313.21, 313.22, 313.23, 313.3, 313.81, 313.82, 313.83, 313.89, 313.9, 314.0, 314.00, 314.01, 314.1, 314.2, 314.8, 314.9, 648.44
Diagnosis for mental illness (ICD-10-CM) [for use 10/01/2014-12/31/2014 REFERENCE ONLY/Not Reportable: 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, F32.8, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.8, F34.9, F39, F42, 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, F53, 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 reporting period (CPT or HCPCS): 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 nonacute facility within the 30-day followup 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.

NOTE: These discharges are excluded from the measure because readmission or transfer may prevent an outpatient follow-up visit from taking place.

NUMERATOR (REPORTING CRITERIA 1)

Patient Received Follow-Up within 30 Days from Discharge An outpatient visit, intensive outpatient visit or partial hospitalization with a mental health practitioner within 30 days after acute inpatient discharge. Include outpatient visits, intensive outpatient visits or partial hospitalizations 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
Medical Performance Exclusion: Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (eg, 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 on the date of discharge or within 30 days after discharge (G9404)


OR


NUMERATOR (REPORTING CRITERIA 2)

Patient Received Follow-Up within 7 Days from Discharge An outpatient visit, intensive outpatient visit or partial hospitalization with a mental health practitioner within 7 days after acute inpatient discharge. Include outpatient visits, intensive outpatient visits or partial hospitalizations that occur on the date of discharge.

Numerator Options:
Performance Met: Patient received follow-up within 7 days from discharge (G9405)
OR
Medical Performance Exclusion: Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (ie,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 on or within 7 days after discharge (G9407)
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Follow-Up After Hospitalization for Mental Illness (FUH)

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