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

Last updated: May 5, 2017

CMS Measure ID: CMS169v5
Version: 5
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 & Medicaid Services (CMS)
Domain: Effective Clinical Care
Next Version: Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use
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: ICD-10 Value Set addition

Specifications

Release Notes

Header

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Updated the Guidance to provide direction on BH Outpatient Psychotherapy encounters.

    Section: Guidance

    Source: Measure Lead

  • Removed parenthetical note from the Numerator header statement. This information is already included in the Guidance.

    Section: Numerator

    Source: Measure Lead

Logic

  • Due to value set updates, created the new variable $BHOutptPsychotherapy to capture BH Outpatient Psychotherapy encounters separately from BH Outpatient encounters.

    Section: Initial Population

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Initial Population

    Source: QDM Standards

  • Simplified the Initial Population logic by combining two 'satisfies any' clauses into a single clause.

    Section: Initial Population

    Source: Measure Lead

  • Simplified the Initial Population logic by removing 'AND: Occurrence A of $BHEncounter'. This statement is redundant as other logic within the Initial Population references Occurrence A of $BHEncounter.

    Section: Initial Population

    Source: Measure Lead

  • The earlier version of this measure contained Initial Population logic that incorrectly referenced the same instance of the $BHEncounter variable in a timing relationship to itself. This issue has been corrected.

    Section: Initial Population

    Source: Measure Lead

  • Updated the Initial Population logic so a BH Outpatient Psychotherapy encounter is evaluated as both an encounter and a treatment.

    Section: Initial Population

    Source: Measure Lead

  • Due to value set updates, created the new variable $BHOutptPsychotherapy to capture BH Outpatient Psychotherapy encounters separately from BH Outpatient encounters.

    Section: Numerator

    Source: Measure Lead

  • The previous Numerator timing logic was not fully meeting the measure intent. Updated timings to 'starts after or concurrent with start of' and 'ends before or concurrent with start of'.

    Section: Numerator

    Source: Measure Lead

  • Updated the Numerator logic so a BH Outpatient Psychotherapy encounter is evaluated as both an encounter and a treatment.

    Section: Numerator

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

  • Due to value set updates, created the new variable $BHOutptPsychotherapy to capture BH Outpatient Psychotherapy encounters separately from BH Outpatient encounters.

    Section: QDM Variables

    Source: Measure Lead

Value Set

  • Value set BH Antidepressant Medication (2.16.840.1.113883.3.1257.1.972): Deleted 1 RXNORM code (1098710).

    Section: None

    Source: None

  • Value set BH Mood Stabilizer Medication (2.16.840.1.113883.3.1257.1.950): Deleted 7 RXNORM codes (865148, 238104, 856706, 856720, 856797, 856825, 856840).

    Section: None

    Source: None

  • Value set BH Outpatient encounter (2.16.840.1.113883.3.464.1.49): Deleted 5 SNOMEDCT codes (108313002, 183382003, 183383008, 75516001, 76168009). Deleted 16 ICD9CM codes. Deleted 1 CPT code (99211). Deleted 11 ICD10PCS codes (GZ50ZZZ, GZ51ZZZ, GZ52ZZZ, GZ53ZZZ, GZ54ZZZ, GZ55ZZZ, GZ56ZZZ, GZ58ZZZ, GZ59ZZZ, GZ72ZZZ, GZHZZZZ).

    Section: None

    Source: None

  • Value set BH Condition Involving Bipolar Disorder (2.16.840.1.113883.3.1257.1.1504): Added 1 ICD10CM code (F34.89).

    Section: None

    Source: ICD-10 Addendum

  • Value set BH Condition Involving Unipolar Depression (2.16.840.1.113883.3.1257.1.1505): Added 2 ICD10CM codes (F32.81, F32.89) and deleted 1 ICD10CM code (F32.8).

    Section: None

    Source: ICD-10 Addendum

External Resources