| Measure Type | High Priority Measure? | NQS Domain |
|---|---|---|
| Process | No | Effective Clinical Care |
| Data Submission Method(s) | ||
| Registry | ||
Measure Description
Percentage of patients with dementia for whom there was a documented symptoms screening* for behavioral and psychiatric symptoms, including depression, AND for whom, if symptoms screening was positive, there was also documentation of recommendations for symptoms management in the last 12 months
Instructions
This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of dementia seen during the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Measure Submission:
The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by 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
All patients with a diagnosis of dementia
Denominator Criteria (Eligible Cases):
All patients regardless of age
AND
Diagnosis for dementia (ICD-10-CM): A52.17, A81.00, A81.01, A81.89, B20, F01.50, F01.51, F02, F02.80, F02.81, F03.90, F03.91, F05, F10.27, G20, G30.0, G30.1, G30.8, G30.9, G31.01, G31.09, G31.83, G31.85, G31.89, G94
AND
Patient encounter during the performance period (CPT): 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 96116, 96118, 96119, 96120, 96127, 96150, 96151, 96152, 96154, 96155, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99487, 99489, 99490, 99497, 99498
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
Numerator
Patients with dementia for whom there was at least one documented symptoms screening* in the last 12 months for at least one symptom each for three domains of behavioral and psychiatric symptoms, including depression and for whom, if symptoms screening was positive, there was also documentation of recommendations for symptoms management in the last 12 months.
Numerator Instructions:
*Symptoms Screening for at least one symptom each for three domains of behavioral and psychiatric symptoms, including depression is defined as using a validated instrument or directly examining the patient or knowledgeable informant to determine the presence or absence of symptoms from three domains activity disturbances, mood disturbances (including depression), and thought and perceptional disturbances. The following is a non-exhaustive list of symptoms falling into each of the three requisite domains pertinent to this measure:
Activity disturbances (To meet measure, patient or knowledgeable informant must be screened for at least one symptom from this list): o Agitation
- Wandering
- Purposeless hyperactivity o Verbal or physical aggressiveness o Resisting care o Apathy o Impulsiveness
- Socially inappropriate behaviors
- Eating disturbances o Sleep problems
- Diurnal/sleep-wake cycle disturbances
- Repetitive behavior
Mood disturbances (To meet measure, patient or knowledgeable informant must be screened for depression and at least one more symptom from this list):
- Anxiety o Elation
- Irritability
- Mood lability/fluctuations
Thought and perceptual disturbances (To meet measure, patient or knowledgeable informant must be screened for at least one symptom from this list:
- Having fixed false beliefs (delusions)
- Hearing or seeing non-present entities (hallucinations) o Paranoia
Examples of reliable and valid instruments that are commonly used in research settings and that can be used to assess behavior include, but are not limited to:
Dementia Signs and Symptoms (DSS) Scale (1) or Neuropsychiatric Inventory (NPI) (2). The assessment of behavioral status may include the assessment of Behavioral and Psychological Symptoms of Dementia (BPSD) (3). For patients residing in nursing homes, it may include an assessment of the behavioral symptom items from the Minimum Data Set (MDS) (4).
NUMERATOR SUBMISSION CRITERIA
Patients who were screened for behavioral and psychiatric symptoms for three domains at least once within the past 12 months
Definitions:
Positive Behavioral and Psychiatric Symptoms Screening includes documentation for at least one symptom for each of three domains: activity disturbances, mood disturbances, thought and perceptual disturbances including depression during an encounter
NUMERATOR NOTE: The 12 month look back period is defined as 12 months from the date of the denominator eligible encounter. In the event that a patient is not screened or partially screened during an eligible encounter for behavioral and psychiatric symptoms or the screening status is unknown submit G9921.
Numerator Options:
Performance Met:
Screening Performed AND Positive AND Provision of Recommendations (G9919)
OR
Performance Met:
Screening Performed AND Negative (G9920)
OR
Performance Not Met:
No Screening Performed, Partial Screening Performed OR Positive Screen Without Recommendations and Reason is Not Given or Not Otherwise Specified (G9921)
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Instructions
This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of dementia seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
All patients with dementia
Denominator Criteria (Eligible Cases):
All patients regardless of age
AND
Diagnosis for dementia (ICD-10-CM): A52.17, A81.00, A81.01, A81.89, B20, F01.50, F01.51, F02.80, F02.81, F03.90, F03.91, F05, F10.27, G30.0, G30.1, G30.8, G30.9, G31.01, G31.09, G31.83, G31.85, G31.89, G94
AND
Patient encounter during the performance period (CPT): 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 96116, 96121, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, 96150, 96151, 96152, 96153, 96154, 96155, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99487, 99489, 99490, 99497, 99498
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
Numerator
Patients with dementia for whom there was a documented screening for behavioral and psychiatric symptoms, including depression in the last 12 months and for whom, if screening was positive, there was also documentation of recommendations for management in the last 12 months
Definition:
Positive Behavioral and Psychiatric Symptoms Screening – Includes documentation for at least one symptom for each of three domains: activity disturbances, mood disturbances, thought and perceptual disturbances including depression during an encounter.
Numerator Instructions:
Symptoms Screening for at least one symptom each for three domains of behavioral and psychiatric symptoms, including depression is defined as using a validated instrument or directly examining the patient or knowledgeable informant to determine the presence or absence of symptoms from three domains: activity disturbances, mood disturbances (including depression), and thought and perceptional disturbances. The following is a non-exhaustive list of symptoms falling into each of the three requisite domains pertinent to this measure:
Activity disturbances (To meet measure, patient or knowledgeable informant must be screened for at least one symptom from this list):
- Agitation
- Wandering
- Purposeless hyperactivity
- Verbal or physical aggressiveness
- Resisting care
- Apathy
- Impulsiveness
- Socially inappropriate behaviors
- Eating disturbances
- Sleep problems
- Diurnal/sleep-wake cycle disturbances
- Repetitive behavior
Mood disturbances (To meet measure, patient or knowledgeable informant must be screened for depression and at least one more symptom from this list):
- Anxiety
- Elation
- Irritability
- Mood lability/fluctuations
Thought and perceptual disturbances (To meet measure, patient or knowledgeable informant must be screened for at least one symptom from this list:
- Having fixed false beliefs (delusions)
- Hearing or seeing non-present entities (hallucinations)
- Paranoia
Examples of reliable and valid instruments that are commonly used in research settings and that can be used to assess behavior include, but are not limited to:
Dementia Signs and Symptoms (DSS) Scale (1) or Neuropsychiatric Inventory (NPI) (2). The assessment of behavioral status may include the assessment of Behavioral and Psychological Symptoms of Dementia (BPSD) (3). For patients residing in nursing homes, it may include an assessment of the behavioral symptom items from the Minimum Data Set (MDS) (4).
NUMERATOR NOTE: The 12 month look back period is defined as 12 months from the date of the denominator eligible encounter. In the event that a patient is not screened or partially screened during an eligible encounter for behavioral and psychiatric symptoms or the screening status is unknown submit G9921.
Numerator Options:
Performance Met: Screening Performed AND Positive AND Provision of Recommendations (G9919)
OR
Performance Met: Screening Performed AND Negative (G9920)
OR
Performance Not Met: No Screening Performed, Partial Screening Performed OR Positive Screen Without Recommendations and Reason is Not Given or Otherwise Specified (G9921)