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Johns Hopkins Health Plans

DSF-E - Depression Screening and Follow-Up for Adolescents and Adults

Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31

Description: 
The percentage of persons 12 years of age and older who were screened for clinical depression using a standardized instrument and, if screened positive, received follow-up care.

  • Depression Screening. The percentage of persons who were screened for clinical depression using a standardized instrument.
  • Follow-Up on Positive Screen. The percentage of persons who received follow-up care within 30 days of a positive depression screen finding.

Stratifications: 
Age as of the start of the measurement period.

  • 12–17 years (commercial and Medicaid only).
  • 18–64 years.
  • 65 years and older.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

  • ECDS.  

Initial Population:

  • Measure Item Count: Person.
  • Age: 12 years of age and older at the start of the measurement period.
  • Benefits: Medical.
  • Continuous Enrollment: The measurement period.
  • Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.

Denominator:
Denominator 1: The initial population minus denominator exclusions.

Denominator 2: Persons from numerator 1 with a positive finding for depression between January 1 and December 1 of the measurement period.

Numerator:
Numerator 1: Depression Screening.
Persons with a documented result for depression screening, using an age-appropriate standardized instrument, performed between January 1 and December 1 of the measurement period.

Numerator 2: Follow-Up on Positive Screen.
Persons who received follow-up care on or up to 30 days after the date of the first positive screen (31 total days). Any of the following on or up to 30 days after the first positive screen:

  • An outpatient, telephone, e-visit or virtual check-in follow-up visit with a diagnosis of depression or other behavioral health condition.
  • A depression case management encounter that documents assessment for symptoms of depression or a diagnosis of depression or other behavioral health condition.
  • A behavioral health encounter, including assessment, therapy, collaborative care or medication management.
  • A dispensed antidepressant medication.
  • A diagnosis of encounter for exercise counseling.

OR

  • Documentation of additional depression screening on a full-length instrument indicating either no depression or no symptoms that require follow-up (i.e., a negative screen) on the same day as a positive screen on a brief screening instrument.

Note: For example, if there is a positive screen resulting from a PHQ-2 score, documentation of a negative finding from a PHQ-9 performed on the same day qualifies as evidence of follow-up.

Depression Screening Instrument (Direct Reference Codes)

A standard assessment instrument that has been normalized and validated for the appropriate patient population. Eligible screening instruments with thresholds for positive findings include:

 

Instruments for Adolescents (≤17 years) Total Score
LOINC Codes		 Positive Finding
Patient Health Questionnaire (PHQ-9)®

44261-6

  Total score ≥10
Patient Health Questionnaire Modified for Teens (PHQ-9M)®

89204-2

 Total score ≥10
Patient Health Questionnaire-2 (PHQ-2)®1 55758-7
 Total score ≥3
Beck Depression Inventory-Fast Screen (BDI-FS)®1,2

89208-3

Total score ≥8
Center for Epidemiologic Studies Depression Scale—Revised (CESD-R) 89205-9
Total score ≥17
Edinburgh Postnatal Depression Scale (EPDS) 99046-5
Total score ≥10
PROMIS Depression

 71965-8
Total score 
(T Score) ≥60
1Brief screening instrument. All other instruments are full-length.
2Proprietary; may be cost or licensing requirement associated with use.
Instruments for Adults (18+ years) Total Score
LOINC Codes		 Positive Finding
Patient Health Questionnaire (PHQ-9)®

44261-6

 Total score ≥10
Patient Health Questionnaire-2 (PHQ-2)®1

55758-7

 Total score ≥3
Beck Depression Inventory-Fast Screen (BDI-FS)®1,2 89208-3 Total score ≥8
Beck Depression Inventory
(BDI-II)

89209-1

 Total score ≥8
Center for Epidemiologic Studies Depression Scale—Revised (CESD-R) 89205-9
 Total score ≥17
Duke Anxiety—Depression Scale (DUKE-AD)®2 90853-3
 Total score ≥30
Geriatric Depression Scale Short Form (GDS)1
 48545-8
 Total score ≥5
Geriatric Depression Scale Long Form (GDS)
 48544-1
Total score ≥10
Edinburg Post-Natal Depression Scale (EPDS)
 99046-5
Total score ≥10
My Mood Monitor (M3)®
 71777-7
Total score ≥5
PROMIS Depression

 71965-8
Total score 
(T Score) ≥60
Clinically Useful Depression Outcome Scale (CUDOS)
 90221-3
Total score ≥31



1Brief screening instrument. All other instruments are full-length.

2Proprietary; may be cost or licensing requirement associated with use. 

Best Practice and Measure Tips

  • This measure requires the use of an age-appropriate screening instrument.
  • Depression screening captured in health risk assessments or other types of health assessments are allowed if the questions align with a specific instrument that is validated for depression screening. For example, if a health risk assessment includes questions from the PHQ-2, it counts as screening if the member answered the questions, and a total score is calculated.
  • Schedule follow-up appointment within 30-day timeframe after a positive PHQ-9 assessment. Track PHQ-9 scores, and adjust treatment as needed.
  • Set alerts if available in EHR or develop a tracking method for members who may need follow-up visits and screenings.
  • Reschedule any canceled appointment and consider offering telehealth visits if in-person visit is not suitable for the patient.
  • Use standardized clinical depression screening templates in charts and in electronic medical records (EMRs).
  • Educate patient about keeping their appointment, adherence to the treatment plan and when to reach out to the provider.
  • Coordinate care: Physicians are encouraged to facilitates the exchange of information with the behavioral health providers.
  • Document all treatment options discussed during the visit in the patient’s chart. When clinically appropriate, provide exercise counseling in addition to prescribing medication, and include diagnosis code Z71.82 to accurately capture this service. Comprehensive documentation supports accurate reporting and helps ensure the member meets compliance standards. 
  • Assess the need for Case Management and refer if necessary.
    • The Johns Hopkins Health Plans Care Management team offers a variety of services to help members who are living with substance abuse and mental health issues may receive confidential care management support and coordination of care from a Licensed Clinical Social Worker. These behavioral health clinicians help members navigate their treatment needs for conditions such as depression, anxiety disorders, addictions, and autism spectrum disorders. For Priority Partners members, we work with Carelon Behavioral Health of Maryland to manage mental health needs.
      • Please send us your member referrals by contacting us at:
        Phone: 800-557-6916
        Monday through Friday: 8 a.m. to 5 p.m.
        Voicemail messages received after normal business hours will be addressed the following business day.
        EHP Behavioral Health: 410-424-4891
        EHP Behavioral Health- Secured: 410-424-4765
        USFHP Mental Health: 410-424-4839
        Advantage MD Behavioral Health, Inpatient & Outpatient: 844-340-2217
        Email: [email protected]

Measure Exclusions

Denominator Exclusions:

  • Persons in hospice or using hospice services any time during the measurement period.
  • Persons who died any time during the measurement period.
  • Persons with a history of bipolar disorder any time during the member's history through the end of the year prior to the measurement period.
  • Persons with depression that starts during the year prior to the measurement period.

Exclusion Codes

Bipolar Disorder

  • ICD-10-CM: 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
  • SNOMED CT US Edition: 162004, 1499003, 3530005, 4441000, 5703000, 9340000, 10875004, 10981006, 13313007, 13581000, 13746004, 14495005, 16506000, 17782008, 21900002, 22121000, 26203008, 26530004, 28663008, 28884001, 29929003, 30935000, 31446002, 33380008, 35481005, 36583000, 38368003, 40926005, 41552001, 41832009, 41836007, 43769008, 45479006, 46229002, 49468007, 49512000, 51637008, 53049002, 53607008, 54761006, 55516002, 59617007, 61403008, 63249007, 64731001, 65042007, 66631006, 68569003, 70546001, 71984005, 73471000, 74686005, 75360000, 75752004, 78269000, 78640000, 79584002, 82998009, 85248005, 86058007, 87203005, 87950005, 111485001, 191618007, 191620005, 191621009, 191623007, 191627008, 191629006, 191630001, 191636007, 191638008, 191639000, 191641004, 191643001, 192362008, 231444002, 371596008, 371599001, 371600003, 723903001, 765176007, 767631007, 767632000, 767633005, 767635003, 767636002, 1343347009, 261000119107, 271000119101, 23741000119105, 133091000119105, 16238741000119105 

Other Bipolar Disorder

  • ICD-10-CM: F31.81, F31.89, F31.9
  • SNOMED CT US Edition: 1196001, 12969000, 16295005, 19300006, 20960007, 22407005, 30520009, 30687003, 34315001, 35722002, 35846004, 43568002, 48937005, 67002003, 71294008, 81319007, 83225003, 371604007, 723905008, 789061003 

Depression

  • ICD-10-CM: F01.511, F01.518, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.81, F32.89, F32.9, F32.A, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.1, F34.81, F34.89, F43.21, F43.23, F53.0, F53.1, O90.6, O99.340, O99.341, O99.342, O99.343, O99.344, O99.345
  • SNOMED CT US Edition: 832007, 2506003, 2618002, 3109008, 14183003, 15193003, 15639000, 18818009, 19527009, 19694002, 20250007, 25922000, 28475009, 33078009, 35489007, 36170009, 36474008, 36923009, 38451003, 38694004, 39809009, 40379007, 40568001, 42925002, 48589009, 63778009, 66344007, 67711008, 69392006, 71336009, 73867007, 75084000, 75837004, 76441001, 77486005, 77911002, 78667006, 79298009, 81319007, 83176005, 84760002, 85080004, 87512008, 191610000, 191611001, 191613003, 191616006, 191659001, 192080009, 231504006, 231542000, 268621008, 319768000, 320751009, 370143000, 430852001, 442057004 

Measure Codes

Follow-up on Positive Screening

An outpatient, telephone, e-visit or virtual check-in follow-up visit

  • CPT: 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972, 98980, 98981, 99078, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242, 99243, 99244, 99245, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99421, 99422, 99423, 99441, 99442, 99443, 99457, 99458, 99483
  • HCPCS: G0071, G0463, G2010, G2012, G2250, G2251, G2252, T1015 NOTE: **T1015 HCPCS code which identifies an all-inclusive clinic visit for services rendered at a Federally Qualified Health Center (FQHC) 
  • SNOMED CT US Edition: 42137004, 50357006, 86013001, 90526000, 108220007, 108221006, 185317003, 185389009, 281036007, 314849005, 386472008, 386473003, 390906007, 401267002, 406547006, 870191006 
  • UBREV: 0510, 0513, 0516, 0517, 0519, 0520, 0521, 0522, 0523, 0526, 0527, 0528, 0529, 0982, 0983

A depression case management encounter

  • CPT: 99366, 99492, 99493, 99494
  • HCPCS: G0512, T1016, T1017, T2022, T2023
  • SNOMED CT US Edition: 182832007, 225333008, 385828006, 386230005, 409022004, 410216003, 410219005, 410328009, 410335001, 410346003, 410347007, 410351009, 410352002, 410353007, 410354001, 410356004, 410360001, 410363004, 410364005, 410366007, 416341003, 416584001, 424490002, 425604002, 737850002, 1344983001, 1344984007, 1344994002, 1345003009, 1345013001, 1345014007, 621561000124106, 661051000124109, 662081000124106, 662541000124107, 842901000000108 
  • Symptoms of Depression SNOMED CT: 394924000, 788976000

Depression or Other Behavioral Health Condition Value Set

  • ICD-10-CM: F01.511, F01.518, F06.4, F10.180, F10.280, F10.980, F11.188, F11.288, F11.988, F12.180, F12.280, F12.980, F13.180, F13.280, F13.980, F14.180, F14.280, F14.980, F15.180, F15.280, F15.980, F16.180, F16.280, F16.980, F18.180, F18.280, F18.980, F19.180, F19.280, F19.980, 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, F32.81, F32.89, F32.9, F32.A, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.81, F34.89, F34.9, F39, F40.00, F40.01, F40.02, F40.10, F40.11, F40.210, F40.218, F40.220, F40.228, F40.230, F40.231, F40.232, F40.233, F40.240, F40.241, F40.242, F40.243, F40.248, F40.290, F40.291, F40.298, F40.8, F40.9, F41.0, F41.1, F41.3, F41.8, F41.9, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.81, F43.89, F43.9, F44.89, F45.21, F51.5, F53.0, F53.1, 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, F68.A, 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, O90.6, O99.340, O99.341, O99.342, O99.343, O99.344, O99.345
  • SNOMED CT US Edition: 109006, 162004, 281004, 600009, 832007, 899001, 1145003, 1196001, 1376001, 1380006, 1383008, 1499003, 1686006, 1816003, 1855002, 1973000, 2312009, 2403008, 2506003, 2618002, 2815001* 
    *Please note that not all SNOMED CT US Edition codes are listed here. For access to the complete set of codes related to DSF-E measure, contact your Provider Engagement Liaison or email [email protected].

A behavioral health encounter, including assessment, therapy, collaborative care or medication management

  • CPT: 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90845, 90846, 90847, 90849, 90853, 90865, 90867, 90868, 90869, 90870, 90875, 90876, 90880, 90887, 99484, 99492, 99493
  • HCPCS: G0155, G0176, G0177, G0409, G0410, G0411, G0511, G0512, H0002, H0004, H0031, H0034, H0035, H0036, H0037, H0039, H0040, H2000, H2001, H2010, H2011, H2012, H2013, H2014, H2015, H2016, H2017, H2018, H2019, H2020, S0201, S9480, S9484, S9485
  • SNOMED CT US Edition: 5694008, 10197000, 10997001, 38756009, 45392008, 79094001, 88848003, 90407005, 91310009, 165171009, 165190001, 225337009, 370803007, 372067001, 385721005, 385724002, 385725001, 385726000, 385727009, 385887004, 385889001, 385890005, 401277000, 410223002, 410224008, 410225009, 410226005, 410227001, 410228006, 410229003, 410230008, 410231007, 410232000, 410233005, 410234004, 439141002 
  • UBREV: 0900, 0901, 0902, 0903, 0904, 0905, 0907, 0911, 0912, 0913, 0914, 0915, 0916, 0917, 0919
  • A diagnosis of encounter for exercise counseling ICD-10-CM code: Z71.82

Measure Medication

Antidepressant Medications

  • Amitriptyline
  • Amitriptyline-chlordiazepoxide
  • Amitriptyline-perphenazine
  • Amoxapine
  • Bupropion
  • Citalopram
  • Clomipramine
  • Desipramine
  • Desvenlafaxine
  • Doxepin
  • Duloxetine
  • Escitalopram
  • Fluoxetine
  • Fluoxetine-olanzapine
  • Fluvoxamine
  • Imipramine
  • Imipramine pamoate
  • Isocarboxazid
  • Levomilnacipran
  • Maprotiline
  • Mirtazapine
  • Nefazodone
  • Nortriptyline
  • Paroxetine
  • Paroxetine mesylate
  • Phenelzine
  • Protriptyline
  • Selegiline
  • Sertraline
  • Tranylcypromine
  • Trazodone
  • Trimipramine
  • Venlafaxine
  • Vilazodone
  • Vortioxetine