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

Measurement Period: January 1 - December 31

Description: 
The percentage of emergency department (ED) visits among persons age 13 years and older with a principal diagnosis of substance use disorder (SUD), or any diagnosis of drug overdose, for which there was follow-up. Two rates are reported:

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

Provider Specialty: Mental Health Practitioner.

Stratifications: 
Age as of the ED visit.

• 13–17 years.
• 18 years 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: 13 years of age or older as of the ED visit. 
• Benefits: Medical, chemical dependency and pharmacy.
  Note: A withdrawal management/detoxification-only chemical dependency benefit does not meet these criteria.
• Continuous Enrollment: The date of the ED visit through 30 days after the ED visit (31 total days).
• Allowable gap: None.

Denominator:
Emergency department visit for substance use.
An ED visit (ED Value Set) with a principal diagnosis of SUD (AOD Abuse and Dependence Value Set) or any diagnosis of drug overdose (Unintentional Drug Overdose 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.

Numerator:

Numerator 1 - 30-Day Follow-Up
Follow-up visit or pharmacotherapy dispensing event on the ED visit date or within 30 days after the ED visit (31 days total). 

Numerator 2 - 7-Day Follow-Up
Follow-up visit or pharmacotherapy dispensing event on the ED visit date or within 7 days after the ED visit (8 days total).

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

• Visits with any diagnosis of SUD, substance use or drug overdose:
  • An outpatient visit (Visit Setting Unspecified Value Set) with any diagnosis of SUD, substance use or drug overdose with any of the following Place of services:
    • Community mental health center POS.
    • Psychiatric Facility-Partial Hospitalization POS.
    • Nonresidential Substance Abuse Treatment Facility POS.
    • Outpatient POS.
    • Psychiatric residential treatment POS.
    • Telehealth POS.
  • A BH outpatient visit.
  • A Partial Hospitalization or Intensive Outpatient.
  • A peer support service.
  • An opioid treatment service that bills monthly or weekly.
  • A telephone visit.
  • An e-visit or virtual check-in.
• Any of the following visits with a Mental Health Provider:
  • An outpatient visit with any of the following Place of services:
    •  Community mental health center POS.
    • Psychiatric Facility-Partial Hospitalization POS.
    • Nonresidential Substance Abuse Treatment Facility POS.
    • Outpatient POS.
    • Psychiatric residential treatment POS.
    • Telehealth POS.
  • A BH outpatient.
  • An intensive outpatient encounter or partial hospitalization with POS code 52
  • Partial Hospitalization or Intensive Outpatient.
  • A non-residential substance abuse treatment facility visit with Nonresidential Substance Abuse Treatment Facility POS.
  • A community mental health center visit with POS code 53.
  • A telehealth visit with Telehealth POS.
  • A telephone visit.
  • An e-visit or virtual check-in.
• A substance use disorder service.
• Substance use disorder counseling and surveillance.
• A behavioral health screening or assessment for SUD or mental health disorders.
• A substance use service.
• A pharmacotherapy dispensing event or medication treatment event. 

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, which must be with a mental health provider.
• Refer patient to a mental health provider to be seen within seven days 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.
  • 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 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.
• A pharmacotherapy dispensing event or medication treatment event meets criteria for a follow-up.

Measure Exclusions

Denominator:

• 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. 
• Exclude ED visits followed by residential treatment on the date of the ED visit or within the 30 days after the ED visit. Any of the following meets criteria for residential treatment:
  
  • Residential Behavioral Health Treatment.
  • Psychiatric Residential Treatment Center (POS code 56).
  • Residential Substance Abuse Treatment Facility (POS code 55).
  • Residential Program Detoxification Value Set.

Note: ED visits followed by inpatient admission and ED visits followed by residential treatment are excluded from the measure because admission to an acute or nonacute inpatient setting may prevent an outpatient follow-up visit from taking place

Numerator Exclusions:

• Laboratory claims (POS 81).
  
   

Exclusion Codes

Residential Behavioral Health Treatment

• HCPCS: H0017, H0018, H0019, T2048

Residential Program Detoxification

• HCPCS: H0010, H0011

Measure Codes

Diagnosis of SUD (AOD Abuse and Dependence)

• ICD-10-CM: F10.10, F10.120, F10.121, F10.129, F10.130, F10.131, F10.132, F10.139, F10.14, F10.150, F10.151, F10.159, F10.180, F10.181, F10.182, F10.188, F10.19, F10.20, F10.220, F10.221, F10.229, F10.230, F10.231, F10.232, F10.239, F10.24, F10.250, F10.251, F10.259, F10.26, F10.27, F10.280, F10.281, F10.282, F10.288, F10.29, F11.10, F11.120, F11.121, F11.122, F11.129, F11.13, F11.14, F11.150, F11.151, F11.159, F11.181, F11.182, F11.188, F11.19, F11.20, F11.220, F11.221, F11.222, F11.229, F11.23, F11.24, F11.250, F11.251, F11.259, F11.281, F11.282, F11.288, F11.29, F12.10, F12.120, F12.121, F12.122, F12.129, F12.13, F12.150, F12.151, F12.159, F12.180, F12.188, F12.19, F12.20, F12.220, F12.221, F12.222, F12.229, F12.23, F12.250, F12.251, F12.259, F12.280, F12.288, F12.29, F13.10, F13.120, F13.121, F13.129, F13.130, F13.131, F13.132, F13.139, F13.14, F13.150, F13.151, F13.159, F13.180, F13.181, F13.182, F13.188, F13.19, F13.20, F13.220, F13.221, F13.229, F13.230, F13.231, F13.232, F13.239, F13.24, F13.250, F13.251, F13.259, F13.26, F13.27, F13.280, F13.281, F13.282, F13.288, F13.29, F14.10, F14.120, F14.121, F14.122, F14.129, F14.13, F14.14, F14.150, F14.151, F14.159, F14.180, F14.181, F14.182, F14.188, F14.19, F14.20, F14.220, F14.221, F14.222, F14.229, F14.23, F14.24, F14.250, F14.251, F14.259, F14.280, F14.281, F14.282, F14.288, F14.29, F15.10, F15.120, F15.121, F15.122, F15.129, F15.13, F15.14, F15.150, F15.151, F15.159, F15.180, F15.181, F15.182, F15.188, F15.19, F15.20, F15.220, F15.221, F15.222, F15.229, F15.23, F15.24, F15.250, F15.251, F15.259, F15.280, F15.281, F15.282, F15.288, F15.29, F16.10, F16.120, F16.121, F16.122, F16.129, F16.14, F16.150, F16.151, F16.159, F16.180, F16.183, F16.188, F16.19, F16.20, F16.220, F16.221, F16.229, F16.24, F16.250, F16.251, F16.259, F16.280, F16.283, F16.288, F16.29, F18.10, F18.120, F18.121, F18.129, F18.14, F18.150, F18.151, F18.159, F18.17, F18.180, F18.188, F18.19, F18.20, F18.220, F18.221, F18.229, F18.24, F18.250, F18.251, F18.259, F18.27, F18.280, F18.288, F18.29, F19.10, F19.120, F19.121, F19.122, F19.129, F19.130, F19.131, F19.132, F19.139, F19.14, F19.150, F19.151, F19.159, F19.16, F19.17, F19.180, F19.181, F19.182, F19.188, F19.19, F19.20, F19.220, F19.221, F19.222, F19.229, F19.230, F19.231, F19.232, F19.239, F19.24, F19.250, F19.251, F19.259, F19.26, F19.27, F19.280, F19.281, F19.282, F19.288, F19.29
• SNOMED CT US Edition: 281004, 1383008, 1686006, 1973000, 2403008, 5002000, 5444000, 5602001, 6348008, 7052005, 7071007, 7200002, 8635005, 8837000, 10327003, 11387009, 14784000, 15167005, 15277004, 18653004*

Diagnosis of Substance Use (Substance Induced Disorders)

• ICD-10-CM: F10.90, F10.920, F10.921, F10.929, F10.930, F10.931, F10.932, F10.939, F10.94, F10.950, F10.951, F10.959, F10.96, F10.97, F10.980, F10.981, F10.982, F10.988, F10.99, F11.90, F11.920, F11.921, F11.922, F11.929, F11.93, F11.94, F11.950, F11.951, F11.959, F11.981, F11.982, F11.988, F11.99, F12.90, F12.920, F12.921, F12.922, F12.929, F12.93, F12.950, F12.951, F12.959, F12.980, F12.988, F12.99, F13.90, F13.920, F13.921, F13.929, F13.930, F13.931, F13.932, F13.939, F13.94, F13.950, F13.951, F13.959, F13.96, F13.97, F13.980, F13.981, F13.982, F13.988, F13.99, F14.90, F14.920, F14.921, F14.922, F14.929, F14.93, F14.94, F14.950, F14.951, F14.959, F14.980, F14.981, F14.982, F14.988, F14.99, F15.90, F15.920, F15.921, F15.922, F15.929, F15.93, F15.94, F15.950, F15.951, F15.959, F15.980, F15.981, F15.982, F15.988, F15.99, F16.90, F16.920, F16.921, F16.929, F16.94, F16.950, F16.951, F16.959, F16.980, F16.983, F16.988, F16.99, F18.90, F18.920, F18.921, F18.929, F18.94, F18.950, F18.951, F18.959, F18.97, F18.980, F18.988, F18.99, F19.90, F19.920, F19.921, F19.922, F19.929, F19.930, F19.931, F19.932, F19.939, F19.94, F19.950, F19.951, F19.959, F19.96, F19.97, F19.980, F19.981, F19.982, F19.988, F19.99
• SNOMED CT US Edition: 281004, 1383008, 1686006, 1973000, 2043009, 2403008, 4863002, 5444000, 6348008, 7052005, 7071007, 7200002, 7916009, 8635005, 8837000, 9953008, 10327003, 11387009, 14784000, 15167005*

Diagnosis of Drug overdose (Unintentional Drug Overdose)

• ICD-10-CM: T40.0X1A, T40.0X1D, T40.0X1S, T40.0X4A, T40.0X4D, T40.0X4S, T40.1X1A, T40.1X1D, T40.1X1S, T40.1X4A, T40.1X4D, T40.1X4S, T40.2X1A, T40.2X1D, T40.2X1S, T40.2X4A, T40.2X4D, T40.2X4S, T40.3X1A, T40.3X1D, T40.3X1S, T40.3X4A, T40.3X4D, T40.3X4S, T40.411A, T40.411D, T40.411S, T40.414A, T40.414D, T40.414S, T40.421A, T40.421D, T40.421S, T40.424A, T40.424D, T40.424S, T40.491A, T40.491D, T40.491S, T40.494A, T40.494D, T40.494S, T40.5X1A, T40.5X1D, T40.5X1S, T40.5X4A, T40.5X4D, T40.5X4S, T40.601A, T40.601D, T40.601S, T40.604A, T40.604D, T40.604S, T40.691A, T40.691D, T40.691S, T40.694A, T40.694D, T40.694S, T40.711A, T40.711D, T40.711S, T40.714A, T40.714D, T40.714S, T40.721A, T40.721D, T40.721S, T40.724A, T40.724D, T40.724S, T40.8X1A, T40.8X1D, T40.8X1S, T40.8X4A, T40.8X4D, T40.8X4S, T40.901A, T40.901D, T40.901S, T40.904A, T40.904D, T40.904S, T40.991A, T40.991D, T40.991S, T40.994A, T40.994D, T40.994S, T41.0X1A, T41.0X1D, T41.0X1S, T41.0X4A, T41.0X4D, T41.0X4S, T41.1X1A, T41.1X1D, T41.1X1S, T41.1X4A, T41.1X4D, T41.1X4S, T41.201A, T41.201D, T41.201S, T41.204A, T41.204D, T41.204S, T41.291A, T41.291D, T41.291S, T41.294A, T41.294D, T41.294S, T41.3X1A, T41.3X1D, T41.3X1S, T41.3X4A, T41.3X4D, T41.3X4S, T41.41XA, T41.41XD, T41.41XS, T41.44XA, T41.44XD, T41.44XS, T41.5X1A, T41.5X1D, T41.5X1S, T41.5X4A, T41.5X4D, T41.5X4S, T42.3X1A, T42.3X1D, T42.3X1S, T42.3X4A, T42.3X4D, T42.3X4S, T42.4X1A, T42.4X1D, T42.4X1S, T42.4X4A, T42.4X4D, T42.4X4S, T43.601A, T43.601D, T43.601S, T43.604A, T43.604D, T43.604S, T43.621A, T43.621D, T43.621S, T43.624A, T43.624D, T43.624S, T43.631A, T43.631D, T43.631S, T43.634A, T43.634D, T43.634S, T43.641A, T43.641D, T43.641S, T43.644A, T43.644D, T43.644S, T43.651A, T43.651D, T43.651S, T43.654A, T43.654D, T43.654S, T43.691A, T43.691D, T43.691S, T43.694A, T43.694D, T43.694S, T51.0X1A, T51.0X1D, T51.0X1S, T51.0X4A, T51.0X4D, T51.0X4S
• SNOMED CT US Edition: 295141006, 295145002, 295150008, 295154004, 295158001, 295163002, 295167001, 295171003, 295175007, 295178009, 295181004, 295185008, 295190006, 295194002, 295198004, 295202002, 295206004, 295210001, 295504002, 295508004

AOD Medication Treatment

• HCPCS: G0533, G2069, G2073, H0020, H0033, J0571, J0572, J0573, J0574, J0575, J0577, J0578, J2315, Q9991, Q9992, S0109
• SNOMED CT US Edition: 310653000

Behavioral Health Assessment

• CPT: 99408, 99409
• HCPCS: G0396, G0397, G0442, G2011, H0001, H0002, H0031, H0049
• SNOMED CT US Edition: 40823001, 49474007, 58473000, 64792006, 89732002, 171208001, 314077000, 370854007, 391281002, 410223002, 410229003, 414283008, 414501008, 415662004, 439320000, 703257008, 713107002, 713127001, 713132000, 713137006, 56871000087106, 428211000124100, 461381000124100

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
• HCPCS: 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 

Online Assessments

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

OUD Monthly Office Based Treatment

• HCPCS: G2069, G2086, G2087

OUD Weekly Drug Treatment Service

• HCPCS: G0533, G2067, G2068, G2070, G2072, G2073

OUD Weekly Non Drug Service

• HCPCS: G2074, G2075, G2076, G2077, G2080

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

Substance Abuse Counseling and Surveillance

• ICD-10-CM: Z71.41, Z71.51

Substance Use Disorder Services

• CPT: 99408, 99409 
• HCPCS: G0396, G0397, G0443, H0001, H0005, H0007, H0015,H0016, H0022, H0047, H0050, H2035, H2036, T1006, T1012 
• SNOMED CT US Edition: 20093000, 23915005, 56876005, 61480009, 64297001, 67516001, 87106005, 182969009, 266707007, 310653000, 370776007, 370854007, 385989002, 386449006, 386450006, 386451005, 414054004, 414056002, 414283008, 414501008, 415662004, 445628007, 445662007, 450760003, 704182008, 707166002, 711008001, 713106006, 713107002, 713127001, 720174008, 720175009, 720176005, 720177001, 763104007, 763233002, 763302001, 772813001, 774090004, 774091000, 792901003, 792902005, 827094004, 865964007, 428211000124100
• UBREV: 0906, 0944, 0945

Substance Use Services

• HCPCS: H0006, H0028
• SNOMED CT US Edition: 4266003, 38670004, 390857005, 396150002, 401266006, 417096006, 417699000, 423416000, 431260004, 719757009, 1254709001

Telephone Visits

• CPT: 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98966, 98967, 98968, 99441, 99442, 99443
• SNOMED CT US Edition: 4266003, 38670004, 390857005, 396150002, 401266006, 417096006, 417699000, 423416000, 431260004, 719757009, 1254709001

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, 99255An Outpatient visit with any of the following Place of Service (POS)
  • Nonresidential Substance Abuse Treatment Facility POS
    • 57- Non-residential Substance Abuse Treatment Facility
    • 58- Non-residential Opioid Treatment Facility
  • 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

*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].

Measure Medication

Alcohol Use Disorder Treatment Medications

• Acamprosate
• Disulfiram
• Naltrexone

Opioid Use Disorder Treatment Medications

• Buprenorphine
• Buprenorphine-naloxone
• Naltrexone