Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use

Last updated: October 25, 2017

CMS Measure ID: CMS169v6
Version: 6
NQF Number: None
Measure Description:

Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use

Initial Patient Population:

Patients 18 years of age or older at the start of the measurement period with a new diagnosis of unipolar depression or bipolar disorder during the first 323 days of the measurement period, and evidence of treatment for unipolar depression or bipolar disorder within 42 days of diagnosis. The existence of a 'new diagnosis' is established by the absence of diagnoses and treatments of unipolar depression or bipolar disorder during the 180 days prior to the diagnosis.

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

None

Numerator Statement:

Patients in the denominator with evidence of an assessment for alcohol or other substance use following or concurrent with the new diagnosis, and prior to or concurrent with the initiation of treatment for that diagnosis

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: Centers for Medicare and Medicaid Services (CMS)
Domain: Effective Clinical Care
Previous Version: Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use
Improvement Notation:

Higher score indicates better quality

Guidance:

The intent of the measure is that the assessment be performed for a single episode for each patient. Due to current limitations of the eMeasure specification system, it is possible for there to be up to two treatment episodes per patient, identified through up to two index episodes. As a result, the numerator criteria of this measure can be satisfied if a substance use assessment is performed within either treatment episode. Future versions of the measure should address this issue.

A BH Outpatient Psychotherapy encounter meets the intent of both an encounter and a treatment.

Addendum Notes: Value Set content updated Sept 2017

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

Logic

  • Revised logic to avoid omitting from the measure those qualifying patients who had only BH Outpatient Psychotherapy encounters. Updated the Initial Population and Numerator to specify that the treatment may occur after the BH Outpatient encounter OR the BH Outpatient Psychotherapy encounter.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Revised logic to avoid omitting from the measure those qualifying patients who had only BH Outpatient Psychotherapy encounters. Updated the Initial Population and Numerator to specify that the treatment may occur after the BH Outpatient encounter OR the BH Outpatient Psychotherapy encounter.

    Measure Section: Numerator

    Source of Change: Measure Lead

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set BH Electroconvulsive Therapy (2.16.840.1.113883.3.1257.1.1533): Deleted 2 ICD9CM codes (94.26, 94.27).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set BH Outpatient Psychotherapy (2.16.840.1.113883.3.1257.1.973): Deleted 16 ICD9CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set BH Outpatient encounter (2.16.840.1.113883.3.464.1.49): Deleted 9 ICD9CM codes (89.01, 89.02, 89.03, 89.04, 89.05, 89.06, 89.07, 89.08, 89.09).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set BH Condition Involving Bipolar Disorder (2.16.840.1.113883.3.1257.1.1504): Deleted 36 ICD9CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set BH Condition Involving Unipolar Depression (2.16.840.1.113883.3.1257.1.1505): Deleted 14 ICD9CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set BH Antidepressant Medication (2.16.840.1.113883.3.1257.1.972): Added 8 RXNORM codes (1738483, 1738495, 1738503, 1738511, 1738515, 1738519, 1738523, 1738527) and deleted 5 RXNORM codes (312239, 312240, 309671, 309672, 835582).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set BH Mood Stabilizer Medication (2.16.840.1.113883.3.1257.1.950): Deleted 1 RXNORM code (312325).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set BH Antidepressant Medication (2.16.840.1.113883.3.1257.1.972): Deleted 8 RXNORM codes (312241, 312243, 312244, 314199, 562790, 562791, 803293, 562815).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources