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

Measurement Period: January 1 - December 31

Description: 
The percentage of emergency department (ED) visits for persons 6 years of age and older with a principal diagnosis of mental illness, or any diagnosis of intentional self-harm, and had a mental health follow-up service. Two rates are reported:

1. The percentage of ED visits for which the person received follow-up within 30 days of the ED visit (31 total days).
2. The percentage of ED visits for which the person received follow-up within 7 days of the ED visit (8 total days).

Stratifications:
Age as of the ED visit.

• 6 -17 years.
• 18 - 64 years.
• 65 and older.

Report stratification by race and ethnicity.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.
• Supplemental.

Initial Population:

• Measure Item Count: Episode.
• Age: 6 years of age and older as of the ED visit.
• Benefits: Medical and mental health.
• Continuous Enrollment: Date of the ED visit through 30 days after the ED visit (31 total days).
• Allowable Gap: None.

Denominator:
Emergency department visit for mental illness.
An ED visit (ED Value Set) with a principal diagnosis of mental illness (Mental Illness Value Set), or any diagnosis of intentional self-harm (Intentional Self Harm Value Set), on or between January 1 and December 1 of the measurement period. 

Note: 

• The measure is based on episodes; therefore, it is possible for the denominator to include multiple events for the same person.
• If a person has more than one ED visit in a 31-day period, only the first eligible ED visit will be included.

Numerators

Numerator 1 - 30-Day Follow-Up
A follow-up service for any diagnosis of a mental health disorder within 30 days after the ED visit (31 total days). Include services that occur on the date of the ED visit.

Numerator 2 - 7-Day Follow-Up
A follow-up service for any diagnosis of a mental health disorder within 7 days after the ED visit (8 total days). Include services that occur on the date of the ED visit.

For both indicators, any of the following meet criteria for a follow-up visit:

• An outpatient visit (Visit Setting Unspecified Value Set) with any diagnosis of a mental health disorder with any of the following Place of services:
  • Community mental health center POS.
  • Psychiatric Facility-Partial Hospitalization POS.
  • Outpatient POS
  • Psychiatric residential treatment POS
  • Telehealth POS
• A BH outpatient visit with any diagnosis of a mental health disorder.
• An intensive outpatient encounter or partial hospitalization with any diagnosis of a mental health disorder.
• Electroconvulsive therapy with Outpatient POS; POS code 24; POS code 52; POS code 53.
• A telephone visit with any diagnosis of a mental health disorder.
• An e-visit or virtual check-in with any diagnosis of a mental health disorder.
• Psychiatric collaborative care management.
• Peer support services with any diagnosis of mental health disorder.
• Psychiatric residential treatment.
• A visit in a behavioral healthcare setting.

Best Practice and Measure Tips

• Visits that occur on the date of ED visit will count toward compliance.
• This measure focuses on follow-up treatment for mental illness or diagnosis of intentional self-harm.
• Refer patient to a mental health provider to be seen within seven days of ED visit.
  • 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]
• Ways to help patients find care they need:
  • Helping them schedule an appointment.
  • Verify if the mental health provider is a good fit by considering location, transportation and time.
  • Identify and address any barriers that may prevent member keeping the appointment.
  • Making sure member has a good support system by engaging parents/guardian or significant others in the treatment plan, stressing the importance of treatment, and attending to their appointment.
  • Ensure member received an appointment with 7 days of ED visit with either their PCP or mental health provider.
  • Share all transition of care with the member’s Primary Care Physician (PCP) and mental health provider to ensure members follows-up with the treatment plan.
  • Ensure member has a PCP.
• Educate member on:
  • Importance of consistency and adherence to the medication regiment.
  • Medication side effect, what to do if the side effect is severe and can potentially result in lack of adherence to the medication regiment and treatment plan.
  • Crisis Intervention options.
• Even patients receiving medication from their primary care provider still need post-discharge supportive therapy with a licensed mental health clinician such as a therapist or social worker.
• Maintain appointment availability for members with recent ED visits.
• Provider should provide reminder calls to confirm appointment within 24 hours.
• If member is unable to keep scheduled appointment, reschedule it or offer Telehealth visits.
• Telehealth visits with a mental health provider are acceptable.
• Submit all claims with correct service coding and principal diagnosis timely.

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.
• Exclude ED visits followed by an admission to an acute or nonacute inpatient care setting on the date of the ED visit or within the 30 days after the ED visit, regardless of the principal diagnosis for the admission.

Measure Codes

Mental Health Diagnosis

• ICD-10-CM: F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, 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, F44.0, F44.1, F44.2, F44.4, F44.5, F44.6, F44.7, F44.81, F44.89, F44.9, F45.0, F45.1, F45.20, F45.21, F45.22, F45.29, F45.41, F45.42, F45.8, F45.9, F48.1, F48.2, F48.8, F48.9, F50.00, F50.010, F50.011, F50.012, F50.013, F50.014, F50.019, F50.020, F50.021, F50.022, F50.023, F50.024, F50.029, F50.20, F50.21, F50.22, F50.23, F50.24, F50.25, F50.810, F50.811, F50.812, F50.813, F50.814, F50.819, F50.82, F50.83, F50.84, F50.89, F50.9, F51.01, F51.02, F51.03, F51.04, F51.05, F51.09, F51.11, F51.12, F51.13, F51.19, F51.3, F51.4, F51.5, F51.8, F51.9, F52.0, F52.1, F52.21, F52.22, F52.31, F52.32, F52.4, F52.5, F52.6, F52.8, F52.9, F53.0, F53.1, F59, 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, F64.0, F64.1, F64.2, F64.8, F64.9, F65.0, F65.1, F65.2, F65.3, F65.4, F65.50, F65.51, F65.52, F65.81, F65.89, F65.9, F66, F68.10, F68.11, F68.12, F68.13, F68.8, F68.A, F69, F80.0, F80.1, F80.2, F80.4, F80.81, F80.82, F80.89, F80.9, F81.0, F81.2, F81.81, F81.89, F81.9, F82, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F88, F89, 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, F95.0, F95.1, F95.2, F95.8, F95.9, F98.0, F98.1, F98.21, F98.29, F98.3, F98.4, F98.5, F98.8, F98.9, F99
• SNOMED CT US Edition: 109006, 162004, 281004, 568005, 596004, 600009, 832007, 1145003, 1196001, 1376001, 1380006, 1383008, 1499003, 1686006, 1816003, 1855002, 1973000, 2312009, 2506003, 2618002, 2815001, 3109008, 3158007, 3530005, 3586005, 4306003, 4441000, 4817008, 4863002, 4926007, 4932002, 4949009, 4997005, 5095008, 5158005, 5464005, 5509004, 5510009*
  
  *Please note that not all SNOMED CT US Edition codes are listed here. For access to the complete set of codes, contact your Provider Engagement Liaison or email [email protected].
  
   

BH Outpatient

• CPT: 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98960, 98961, 98962, 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, 99483, 99492, 99493, 99494, 99510
• HPCPS: G0155, G0176, G0177, G0409, G0463, G0512, G0560, H0002, H0004, H0031, H0034, H0036, H0037, H0039, H0040, H2000, H2010, H2011, H2013, H2014, H2015, H2016, H2017, H2018, H2019, H2020, 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: 50357006, 77406008, 84251009, 86013001, 90526000, 185463005, 185464004, 185465003, 209099002, 281036007, 391223001, 391224007, 391225008, 391233009, 391237005, 391239008, 391242002, 391257009, 391260002, 391261003, 439740005, 866149003, 3391000175108, 444971000124105, 456201000124103
• UBREV: 0510, 0513, 0515, 0516, 0517, 0519, 0520, 0521, 0522, 0523, 0526, 0527, 0528, 0529, 0900, 0902, 0903, 0904, 0911, 0914, 0915, 0916, 0917, 0919, 0982, 0983

Behavioral Healthcare Setting

• UBREV: 0513, 0900, 0901, 0902, 0903, 0904, 0905, 0907, 0911, 0912, 0913, 0914, 0915, 0916, 0917, 0919, 1001

Electroconvulsive Therapy

• CPT: 90870
• ICD-10-PCS: GZB0ZZZ, GZB2ZZZ, GZB4ZZZ
• SNOMED CT US Edition: 10470002, 11075005, 23835007, 231079005, 231080008, 284468008, 313019002, 313020008, 1010696002, 1010697006
• Electroconvulsive therapy with the following Place of Service (POS)
  • 24- Ambulatory Surgical Center
  • 52- Psychiatric Facility-Partial Hospitalization
  • 53- Community Mental Health Center
  • Outpatient POS:
    • 03- School
    • 05- Indian Health Service Free-standing Facility
    • 07- Tribal 638 Free-standing Facility
    • 09- Prison/Correctional Facility
    • 11- Office
    • 12- Home
    • 13- Assisted Living Facility
    • 14- Group Home
    • 15- Mobile Unit
    • 16- Temporary Lodging
    • 17- Walk-in Retail Health Clinic
    • 18- Place of Employment-Worksite
    • 19- Off Campus-Outpatient Hospital
    • 20- Urgent Care Facility
    • 22- On Campus-Outpatient Hospital
    • 33- Custodial Care Facility
    • 49- Independent Clinic
    • 50- Federally Qualified Health Center
    • 71- Public Health Clinic
    • 72- Rural Health Clinic

Online Assessments

• CPT: 98016, 98970, 98971, 98972, 98980, 98981, 99421, 99422, 99423, 99457, 99458
• HCPCS: G0071, G2010, G2012, G2250, G2251, G2252

Partial Hospitalization or Intensive Outpatient

• HCPCS: G0410, G0411, H0035, H2001, H2012, S0201, S9480, S9484, S9485
• SNOMED CT US Edition: 7133001, 305345009, 305346005, 305347001, 391038005, 391042008, 391043003, 391046006, 391047002, 391048007, 391054008, 391055009, 391056005, 391133003, 391150001, 391151002, 391152009, 391153004, 391170007, 391185001, 391186000, 391187009, 391188004, 391191004, 391192006, 391194007, 391195008, 391207001, 391208006, 391209003, 391210008, 391211007, 391228005, 391229002, 391232004, 391252003, 391254002, 391255001, 391256000
• UBREV: 0905, 0907, 0912, 0913

Peer Support Services

• HCPCS: G0140, G0177, H0024, H0025, H0038, H0039, H0040, H0046, H2014, H2023, S9445, T1012, T1016, T1017

Psychiatric Collaborative Care Management

• CPT: 99492, 99493, 99494
• HCPCS: G0512

Residential Behavioral Health Treatment

• HCPCS: H0017, H0018, H0019, T2048

Telephone Visits

• CPT: 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98966, 98967, 98968, 99441, 99442, 99443
• SNOMED CT US Edition: 185317003. 314849005. 386472008. 386473003. 401267002

Outpatient visit (Visit Setting Unspecified)

• CPT: 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90847, 90849, 90853, 90875, 90876, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99252, 99253, 99254, 99255
• An Outpatient visit with any of the following Place of Service (POS)
  • Outpatient POS
    • 03- School
    • 05- Indian Health Service Free-standing Facility
    • 07- Tribal 638 Free-standing Facility
    • 09- Prison/Correctional Facility
    • 11- Office
    • 12- Home
    • 13- Assisted Living Facility
    • 14- Group Home
    • 15- Mobile Unit
    • 16- Temporary Lodging
    • 17- Walk-in Retail Health Clinic
    • 18- Place of Employment-Worksite
    • 19- Off Campus-Outpatient Hospital
    • 20- Urgent Care Facility
    • 22- On Campus-Outpatient Hospital
    • 33- Custodial Care Facility
    • 49- Independent Clinic
    • 50- Federally Qualified Health Center
    • 71- Public Health Clinic
    • 72- Rural Health Clinic
  • Telehealth POS
    • 02- Telehealth Provided Other than in Patient’s Home
    • 10- Telehealth Provided in Patient’s Home
  • 52- Psychiatric Facility-Partial Hospitalization
  • 53- Community Mental Health Center
  • 56- Psychiatric Residential Treatment Center