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1 Measure #391 (NQF 0576): Follow-Up After Hospitalization for Mental Illness (FUH) National Quality Strategy Domain: Communication and Care Coordination 2015 PHYSICIAN QUALITY REPTING OPTIONS F INDIVIDUAL MEASURES REGISTRY ONLY 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 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 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 2) The percentage of discharges for which the patient received follow-up within 7 days of discharge Measure Reporting via Registry: ICD-9-CM/ICD-10-CM diagnosis codes, CPT or HCPCS codes, and patient demographics 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. There are two reporting criteria for this measure: 1) The percentage of discharges for which the patient received follow-up within 30 days of discharge 10/10/2014 Page 537 of 593
2 2) The percentage of discharges for which the patient received follow-up within 7 days of discharge REPTING CRITERIA 1: The percentage of discharges for which the patient received follow-up within 30 days of discharge DENOMINAT (REPTING 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 Denominator Criteria (Eligible Cases) 1: Patients aged 6 years and older as of the date of discharge Diagnosis for mental illness (ICD-9-CM) [for use 1/1/2014-9/30/2014]:, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 296.7, , , , , , , 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, , , , , , , , , 300.3, 300.4, 301.0, , , , , , , , 301.3, 301.4, , , , 301.6, 301.7, , , , , , 301.9, 308.0, 308.1, 308.2, 308.3, 308.4, 308.9, 309.0, 309.1, , , , , , , 309.3, 309.4, , , , ,309.9, 311, , , , , , , , , , , , , , , , , , , , 312.4, , , , 312.9, 313.0, 313.1, , , , 313.3, , , , , 313.9, , , 314.1, 314.2, 314.8, 314.9, Diagnosis for mental illness (ICD-10-CM) [for use 10/01/ /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 Patient encounter during the reporting period (CPT or HCPCS): 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, Patient alive at time of acute inpatient setting discharge Patient is discharged from an acute inpatient setting on or between January 1 and December 1 of the 10/10/2014 Page 538 of 593
3 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. NUMERAT (REPTING 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: Medical Performance Exclusion: Performance Not Met: Patient received follow-up on the date of discharge or within 30 days after discharge (G9402) 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) Patient did not receive follow-up on the date of discharge or within 30 days after discharge (G9404) REPTING CRITERIA 2: The percentage of discharges for which the patient received follow-up within 7 days of discharge DENOMINAT (REPTING 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 Denominator Criteria (Eligible Cases) 2: Patients aged 6 years and older as of the date of discharge Diagnosis for mental illness (ICD-9-CM) [for use 1/1/2014-9/30/2014]:, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 296.7, , , , , , , 297.0, 297.1, 297.2, 297.3, 297.8, , 298.1, 298.2, 298.3, 298.4, 298.8, 298.9, , , , , , , 299.9, , , 300.3, 300.4, 301.0, , , , , , , , 301.3, 301.4, , , , 301.6, 301.7, , , , , , 301.9, 308.0, 308.1, 10/10/2014 Page 539 of 593
4 308.2, 308.3, 308.4, 308.9, 309.0, 309.1, , , ,309.24, , , 309.3, 309.4, , , , ,309.9, 311, 312.0, , , , , , , , , , , , , , , , , , , , 312.4, , , , 312.9, 313.0, 313.1, , , , 313.3, , , , , 313.9, 314.0, , , 314.1, 314.2, 314.8, 314.9, Diagnosis for mental illness (ICD-10-CM) [for use 10/01/ /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 Patient encounter during the reporting period (CPT or HCPCS): 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, Patient alive at time of acute inpatient setting discharge Patient is discharged from an acute inpatient setting on or between January 1 and December 1 of the 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. NUMERAT (REPTING 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: Medical Performance Exclusion: Performance Not Met: Patient received follow-up within 7 days from discharge (G9405) 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) Patient did not receive follow-up on or within 7 days after discharge (G9407) 10/10/2014 Page 540 of 593
5 RATIONALE: It is important to provide regular follow-up therapy to patients after they have been hospitalized for mental illness. An outpatient visit with a mental health practitioner after discharge is recommended to make sure that the patient s transition to the home or work environment is supported and that gains made during hospitalization are not lost. It also helps health care providers detect early post-hospitalization reactions or medication problems and provide continuing care. This measure is consistent with guidelines of the National Institute of Mental Health and the Centers for Mental Health Services. CLINICAL RECOMMENDATION STATEMENTS: According to a guideline developed by the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association, there is a need for regular and timely assessments and documentation of the patient s response to all treatments. The organization should make a practice of helping schedule follow-up appointments when a patient is discharged, as part of the treatment or case management plan, and should educate patients and practitioners about the importance of follow-up visits. Systems should be established to generate reminder or reschedule notices that are mailed to patients in the event that a follow-up visit is missed or canceled. In many cases, it may also be necessary to develop outreach systems or assign case managers to encourage recently released patients to keep follow-up appointments or reschedule missed appointments. 10/10/2014 Page 541 of 593
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